Healthcare utilization and cost of systemic lupus erythematosus in a US managed care health plan

J Med Econ. 2013;16(5):667-77. doi: 10.3111/13696998.2013.778270. Epub 2013 Mar 11.


Objective: To assess healthcare resource utilization and costs in a cohort of US managed care patients with systemic lupus erythematosus (SLE).

Methods: Claims data from a large managed care plan were used to identify patients of 18-64 years old with SLE-related claims from 2004-2005. Algorithms were developed to retrospectively categorize patients by disease severity and identify flare episodes by flare severity. Descriptive and multivariate analyses were performed to estimate healthcare resource utilization and costs over a 2-year period for the cohort overall and by disease and flare severity.

Results: Among the 2990 patients in the study cohort, disease severity was mild in 789 (26.4%), moderate in 1558 (52.1%), and severe in 643 (21.5%). During the 2-year follow-up period, SLE patients utilized the following categories of care: office visit (99.7%), laboratory service (99.5%), outpatient hospital visit (76.0%), emergency room visit (45.6%), and inpatient hospital stay (26.4%). Mean total unadjusted healthcare cost per patient was $30,010 over the 2-year follow-up period, with medical and pharmacy costs comprising 76.5% and 23.5% of total expenditures, respectively. Additionally, 95.7% of patients had one or more flares, with a mean (SD) of 6.7 (3.6) flares during the 2-year follow-up period. The average unadjusted cost per mild, moderate, and severe flare, respectively, was $909, $1539, and $17,059, most of which was for medical cost rather than pharmacy cost. The frequency and cost of flares increased with disease severity.

Limitations: The disease severity and flare severity algorithms were based upon managed care claims data; the algorithm was not verified clinically and may not be generalizable to other health plans.

Conclusions: SLE is associated with high levels of healthcare utilization and costs in a managed care health plan. Inpatient hospital stays were the primary medical cost drivers, followed by physician office visits and outpatient hospital visits.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Services / economics*
  • Health Services / statistics & numerical data*
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Lupus Erythematosus, Systemic / economics*
  • Lupus Erythematosus, Systemic / therapy*
  • Male
  • Managed Care Programs / statistics & numerical data*
  • Middle Aged
  • Patient Acuity
  • Retrospective Studies
  • United States
  • Young Adult