Health care utilization and costs of systemic lupus erythematosus in the United States: A systematic review

Abstract

Objectives To evaluate health care utilization and costs for patients with systemic lupus erythematosus (SLE) by disease severity. Methods We searched PubMed and Embase from January 2000 to June 2020 for observational studies examining health care utilization and costs associated with SLE among adults in the United States. Two independent reviewers reviewed the selected full-text articles to determine the final set of included studies. Costs were converted to 2020 US $. Results We screened 9224 articles, of which 51 were included. Mean emergency department visits were 0.3–3.5 per year, and mean hospitalizations were 0.1–2.4 per year (mean length of stay 0.4–13.0 days). Patients averaged 10–26 physician visits/year. Mean annual direct total costs were $17,258–$63,022 per patient and were greater for patients with moderate or severe disease ($19,099–$82,391) compared with mild disease ($12,242–$29,233). Mean annual direct costs were larger from commercial claims ($24,585–$63,022) than public payers (Medicare and Medicaid: $18,302–$27,142). Conclusions SLE remains a significant driver of health care utilization and costs. Patients with moderate to severe SLE use more health care services and incur greater direct and indirect costs than those with mild disease.