Treatment Patterns and Health Care Costs of Lupus Nephritis in a United States Payer Population
Received 8 February 2020
Accepted for publication 21 May 2020
Published 22 June 2020 Volume 2020:12 Pages 117—124
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Chuan-Ju Liu
Laura Bartels-Peculis,1 Ajay Sharma,2 Alison M Edwards,2 Anirudh Sanyal,2 Erin Connolly-Strong,1 Winnie W Nelson1
1Mallinckrodt Pharmaceuticals, Inc., Bedminster, NJ, USA; 2Healthagen LLC, New York, NY 10017, USA
Correspondence: Laura Bartels-Peculis Email firstname.lastname@example.org
Objective: To describe the characteristics, treatment patterns, health care resource utilization (HCRU), and cost of care for members of a large United States (US) health insurance plan with lupus nephritis (LN).
Methods: A retrospective observational study was conducted using a health insurance plan database to identify adult members with a diagnosis of LN. Medical and pharmacy claims were used to describe demographics, comorbidities, HCRU, and cost patterns over a 12-month follow-up period for each patient, between January 1, 2014, and December 31, 2016. All study variables were examined descriptively.
Results: A total of 1039 patients were available for analysis (median age, 47 years; 83% female). The median Charlson Comorbidity Index (CCI) was 3.3. Less than half (41%) of patients received immunosuppressive therapies commonly used to treat LN. Evidence indicated that 58% of the study population were prescribed corticosteroid therapy, in most cases (73%) for more than 60 days. Adverse events known to be associated with corticosteroid therapy were recorded in 58% of patients. Guideline-recommended preventive therapy with hydroxychloroquine was prescribed for 54% of members with LN. Nearly half (47%) of members with LN did not see a nephrologist and more than one-third (36%) did not see a rheumatologist over 1 year of follow-up. Rates of all-cause hospitalization and emergency department (ED) use were 25% and 35%, respectively. The mean all-cause per-member-per-month (PMPM) medical cost for the study population was $2801, with LN-specific costs accounting for $1147 PMPM.
Conclusion: Patients with LN who are insured through a large US health plan appeared to underutilize outpatient specialist services and guideline-recommended hydroxychloroquine therapy. Corticosteroid use and adverse events known to be associated with corticosteroids were common in this cohort.
Keywords: lupus nephritis, provider visits, health care resource utilization, health care costs, real-world evidence
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