Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

A Systematic Literature Review of the Direct Costs of Systemic Lupus Erythematosus (SLE) in the United States (US).

Slawsky1,  Katherine A., Fernandes2,  Ancilla, Manzi3,  Susan, Fusfeld1,  Lauren, Goss1,  Thomas F.

Boston Healthcare Associates, Inc., Boston MA and Washington DC
MedImmune LLC, Gaithersburg, MD
West Penn Allegheny Health System, Pittsburgh, PA


SLE is a chronic autoimmune disorder characterized by acute flares and remissions. Patients are generally managed with multiple medications depending on disease severity, tolerance, and organ system affected. SLE is thought to be associated with high symptom and economic burden; here, we review annual direct medical costs associated with SLE among adults in the US.


English-language studies published between 01/2000 and 04/2010 were systematically reviewed from both MEDLINE PubMed and the Cochrane databases. Studies were included if they reported direct medical costs of SLE among adults in the US.


Nine studies reporting direct costs associated with SLE in the US and published since 01/2000 were identified, Five were excluded: one focused on a pediatric population, a review with no pooled- or meta-analyses, one study that reported no actual cost estimates and two studies that applied Canadian costs to US patients. A summary of the selected four studies is presented in Table 1 below.

Table 1. Results Summary

Data SourceStudy 1: Commercial ClaimsStudy 2: Commercial ClaimsStudy 3: Medicaid ClaimsStudy 4: Patient Self-reported Resource Utilization
Sample size6,26915,5902,298815
Year of data analysis*2005200620062004
Mean annual direct cost per SLE patient (all patients) (SD)$20,926 ($45,093)N/A$17,009 ($27,531)$13,735 ($25,792)
Mean annual direct cost per SLE patient without nephritis (SD)$16,575 ($29,300)$12,273 ($27,096)$13,758N/A
Mean annual direct cost per SLE patient with nephritis (SD)$62,651 ($106,745)$31,274 ($52,800)$29,034 ($41,876)N/A
Mean annual direct cost per control patient (SD)$7,794 ($22,014)N/A$9,788 ($18,078)N/A
*All costs included to 2009 values using the GDP calculator, available http:GDP.html

Studies examined main cost categories of inpatient, outpatient, and pharmacy services, all of which contributed substantially to total costs, although the relative contribution of each main cost category varied. Median costs were consistently lower than means reported, suggesting outliers may skew overall mean costs. With the exception of study 4, all studies examined annual costs of newly diagnosed or newly active patients. No identified studies explicitly examined costs of specific treatments or disease manifestations (other than nephritis), or disease severity. Methodologies varied across studies, with patient self-reported resource utilization generating the lowest estimates vs. claims analyses; Medicaid claims analyses generated lower incremental cost estimates for SLE patients vs. control patients compared to commercial claims analysis.


SLE is associated with substantial annual direct cost burden in the US; however, little research has been done examining costs associated with specific treatments, cost variation by disease severity, and disease manifestations. It is important to investigate the variation in costs due to disease severity and manifestations as newer and more expensive biologic therapies continue to emerge.

To cite this abstract, please use the following information:
Slawsky, Katherine A., Fernandes, Ancilla, Manzi, Susan, Fusfeld, Lauren, Goss, Thomas F.; A Systematic Literature Review of the Direct Costs of Systemic Lupus Erythematosus (SLE) in the United States (US). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :754
DOI: 10.1002/art.28522

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