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Abstract：
BACKGROUND: We aimed to describe healthcare resource utilization (HCRU) and healthcare costs in patients with newly confirmed lupus nephritis (LN) in the United States over a 5-year follow-up period.
METHODS: This retrospective, longitudinal cohort study (GSK Study 214102) utilized administrative claims data to identify individuals with a newly confirmed diagnosis of LN between August 01, 2011, and July 31, 2018, based on LN-specific International Classification of Diseases diagnosis codes. Index was the date of first LN-related diagnosis code claim. HCRU, healthcare costs, and incidence of systemic lupus erythematosus (SLE) flares were reported annually among eligible patients with at least 5 years continuous enrollment post-index.
RESULTS: Of 2,159 patients with a newly confirmed diagnosis of LN meeting inclusion and exclusion criteria, 335 had at least 5 years continuous enrollment post-index. HCRU was greatest in the first year post-LN diagnosis across all categories (inpatient admission, emergency room [ER] visits, ambulatory visits, and pharmacy use), and trended lower, though remained substantial, in the 5-year follow-up period. Among patients with LN and HCRU, the mean (standard deviation [SD]) number of ER visits and inpatient admissions were 3.7 (4.6) and 1.8 (1.5), respectively, in Year 1, which generally remained stable in Years 2-5; the mean (SD) number of ambulatory visits and pharmacy fills were 35.8 (25.1) and 62.9 (43.8), respectively, in Year 1, and remained similar for Years 2-5. Most patients (≥ 91.6%) had ≥ 1 SLE flare in each of the 5 years of follow-up. The proportion of patients who experienced a severe SLE flare was higher in Year 1 (31.6%) than subsequent years (14.3-18.5%). Total costs (medical and pharmacy; mean [SD]) were higher in Year 1 ($44,205 [71,532]) than subsequent years ($29,444 [52,310]-$32,222 [58,216]), driven mainly by inpatient admissions (Year 1: $21,181 [58,886]; subsequent years: $7,406 [23,331]-$9,389 [29,283]).
CONCLUSIONS: Patients with a newly confirmed diagnosis of LN have substantial HCRU and healthcare costs, particularly in the year post-diagnosis, largely driven by inpatient costs. This highlights the need for improved disease management to prevent renal damage, improve patient outcomes, and reduce costs among patients with renal involvement.
METHODS: This retrospective, longitudinal cohort study (GSK Study 214102) utilized administrative claims data to identify individuals with a newly confirmed diagnosis of LN between August 01, 2011, and July 31, 2018, based on LN-specific International Classification of Diseases diagnosis codes. Index was the date of first LN-related diagnosis code claim. HCRU, healthcare costs, and incidence of systemic lupus erythematosus (SLE) flares were reported annually among eligible patients with at least 5 years continuous enrollment post-index.
RESULTS: Of 2,159 patients with a newly confirmed diagnosis of LN meeting inclusion and exclusion criteria, 335 had at least 5 years continuous enrollment post-index. HCRU was greatest in the first year post-LN diagnosis across all categories (inpatient admission, emergency room [ER] visits, ambulatory visits, and pharmacy use), and trended lower, though remained substantial, in the 5-year follow-up period. Among patients with LN and HCRU, the mean (standard deviation [SD]) number of ER visits and inpatient admissions were 3.7 (4.6) and 1.8 (1.5), respectively, in Year 1, which generally remained stable in Years 2-5; the mean (SD) number of ambulatory visits and pharmacy fills were 35.8 (25.1) and 62.9 (43.8), respectively, in Year 1, and remained similar for Years 2-5. Most patients (≥ 91.6%) had ≥ 1 SLE flare in each of the 5 years of follow-up. The proportion of patients who experienced a severe SLE flare was higher in Year 1 (31.6%) than subsequent years (14.3-18.5%). Total costs (medical and pharmacy; mean [SD]) were higher in Year 1 ($44,205 [71,532]) than subsequent years ($29,444 [52,310]-$32,222 [58,216]), driven mainly by inpatient admissions (Year 1: $21,181 [58,886]; subsequent years: $7,406 [23,331]-$9,389 [29,283]).
CONCLUSIONS: Patients with a newly confirmed diagnosis of LN have substantial HCRU and healthcare costs, particularly in the year post-diagnosis, largely driven by inpatient costs. This highlights the need for improved disease management to prevent renal damage, improve patient outcomes, and reduce costs among patients with renal involvement.
摘要：
背景：我们旨在描述美国新确诊的狼疮性肾炎（LN）患者在5年随访期间的医疗资源利用（HCRU）和医疗费用。
方法：本回顾性研究，纵向队列研究(GSKStudy214102)利用2011年8月1日至2018年7月31日期间的行政索赔数据,根据LN特异性国际疾病分类诊断代码,确定新确诊为LN的个体.索引是第一个与LN相关的诊断代码索赔的日期。HCCU,医疗费用,和系统性红斑狼疮(SLE)耀斑的发生率每年在符合入选条件的患者中报告,这些患者在入选后至少5年连续入选.
结果：在2,159例新确诊的符合纳入和排除标准的LN患者中，335名具有至少5年的连续入学后指数。HCRU在所有类别的LN诊断后的第一年中最大（住院，急诊室[ER]访问，门诊探视,和药房使用)，趋势更低，虽然仍然很大，在5年的随访期间。在患有LN和HCRU的患者中，平均(标准差[SD])急诊就诊次数和住院次数分别为3.7(4.6)和1.8(1.5)，分别,在第1年，在第2-5年总体保持稳定；门诊就诊和药房填充的平均（SD）数量为35.8（25.1）和62.9（43.8），分别,在第1年，并在第2-5年保持相似。大多数患者（≥91.6％）在5年的随访中每年出现≥1次SLE发作。第1年经历严重SLE发作的患者比例（31.6％）高于随后几年（14.3-18.5％）。第1年的总费用（医疗和药房；平均[SD]）高于随后的年份（$44,205[71,532]）（$29,444[52,310]-$32,222[58,216]），主要由住院患者驱动（第一年：21,181美元[58,886]；随后几年：7,406美元[23,331]-9,389美元[29,283]）。
结论：新确诊为LN的患者有大量的HCRU和医疗费用，特别是在诊断后的那一年，很大程度上是由住院费用驱动的。这凸显了改善疾病管理以防止肾脏损害的必要性，改善患者预后，并降低肾脏受累患者的费用。
方法：本回顾性研究，纵向队列研究(GSKStudy214102)利用2011年8月1日至2018年7月31日期间的行政索赔数据,根据LN特异性国际疾病分类诊断代码,确定新确诊为LN的个体.索引是第一个与LN相关的诊断代码索赔的日期。HCCU,医疗费用,和系统性红斑狼疮(SLE)耀斑的发生率每年在符合入选条件的患者中报告,这些患者在入选后至少5年连续入选.
结果：在2,159例新确诊的符合纳入和排除标准的LN患者中，335名具有至少5年的连续入学后指数。HCRU在所有类别的LN诊断后的第一年中最大（住院，急诊室[ER]访问，门诊探视,和药房使用)，趋势更低，虽然仍然很大，在5年的随访期间。在患有LN和HCRU的患者中，平均(标准差[SD])急诊就诊次数和住院次数分别为3.7(4.6)和1.8(1.5)，分别,在第1年，在第2-5年总体保持稳定；门诊就诊和药房填充的平均（SD）数量为35.8（25.1）和62.9（43.8），分别,在第1年，并在第2-5年保持相似。大多数患者（≥91.6％）在5年的随访中每年出现≥1次SLE发作。第1年经历严重SLE发作的患者比例（31.6％）高于随后几年（14.3-18.5％）。第1年的总费用（医疗和药房；平均[SD]）高于随后的年份（$44,205[71,532]）（$29,444[52,310]-$32,222[58,216]），主要由住院患者驱动（第一年：21,181美元[58,886]；随后几年：7,406美元[23,331]-9,389美元[29,283]）。
结论：新确诊为LN的患者有大量的HCRU和医疗费用，特别是在诊断后的那一年，很大程度上是由住院费用驱动的。这凸显了改善疾病管理以防止肾脏损害的必要性，改善患者预后，并降低肾脏受累患者的费用。
