Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach

Megan R.W. Barber, John G. Hanly, Li Su, Murray B. Urowitz, Yvan St. Pierre, Juanita Romero-Diaz, Caroline Gordon, Sang Cheol Bae, Sasha Bernatsky, Daniel J. Wallace, David A. Isenberg, Anisur Rahman, Ellen M. Ginzler, Michelle Petri, Ian N. Bruce, Paul R. Fortin, Dafna D. Gladman, Jorge Sanchez-Guerrero, Rosalind Ramsey-Goldman, Munther A. Khamashta & 20 others Cynthia Aranow, Meggan Mackay, Graciela S. Alarcón, Susan Manzi, Ola Nived, Andreas Jönsen, Asad A. Zoma, Ronald F. van Vollenhoven, Manuel Ramos-Casals, Guillermo Ruiz-Irastorza, S. Sam Lim, Kenneth C. Kalunian, Murat Inanc, Diane L. Kamen, Christine A. Peschken, Soren Jacobsen, Anca Askanase, Chris Theriault, Vernon Farewell, Ann E. Clarke

Research output: Contribution to journalArticle

Abstract

Objective: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. Methods: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. Results: A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) <30 ml/minute ($310,579 2015 Canadian dollars versus $19,987 if no LN and estimated GFR >60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria <0.25 gm/day). Conclusion: Patients with estimated GFR <30 ml/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies.

Original languageEnglish (US)
Pages (from-to)1294-1302
Number of pages9
JournalArthritis Care and Research
Volume70
Issue number9
DOIs
StatePublished - Sep 1 2018

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Lupus Nephritis
Cost-Benefit Analysis
Glomerular Filtration Rate
Costs and Cost Analysis
Kidney
Proteinuria
Cost of Illness
Health Care Costs
Dialysis
Hospitalization
Biopsy

ASJC Scopus subject areas

  • Rheumatology

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Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach. / Barber, Megan R.W.; Hanly, John G.; Su, Li; Urowitz, Murray B.; St. Pierre, Yvan; Romero-Diaz, Juanita; Gordon, Caroline; Bae, Sang Cheol; Bernatsky, Sasha; Wallace, Daniel J.; Isenberg, David A.; Rahman, Anisur; Ginzler, Ellen M.; Petri, Michelle; Bruce, Ian N.; Fortin, Paul R.; Gladman, Dafna D.; Sanchez-Guerrero, Jorge; Ramsey-Goldman, Rosalind; Khamashta, Munther A.; Aranow, Cynthia; Mackay, Meggan; Alarcón, Graciela S.; Manzi, Susan; Nived, Ola; Jönsen, Andreas; Zoma, Asad A.; van Vollenhoven, Ronald F.; Ramos-Casals, Manuel; Ruiz-Irastorza, Guillermo; Lim, S. Sam; Kalunian, Kenneth C.; Inanc, Murat; Kamen, Diane L.; Peschken, Christine A.; Jacobsen, Soren; Askanase, Anca; Theriault, Chris; Farewell, Vernon; Clarke, Ann E.

In: Arthritis Care and Research, Vol. 70, No. 9, 01.09.2018, p. 1294-1302.

Research output: Contribution to journalArticle

Barber, MRW, Hanly, JG, Su, L, Urowitz, MB, St. Pierre, Y, Romero-Diaz, J, Gordon, C, Bae, SC, Bernatsky, S, Wallace, DJ, Isenberg, DA, Rahman, A, Ginzler, EM, Petri, M, Bruce, IN, Fortin, PR, Gladman, DD, Sanchez-Guerrero, J, Ramsey-Goldman, R, Khamashta, MA, Aranow, C, Mackay, M, Alarcón, GS, Manzi, S, Nived, O, Jönsen, A, Zoma, AA, van Vollenhoven, RF, Ramos-Casals, M, Ruiz-Irastorza, G, Lim, SS, Kalunian, KC, Inanc, M, Kamen, DL, Peschken, CA, Jacobsen, S, Askanase, A, Theriault, C, Farewell, V & Clarke, AE 2018, 'Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach', Arthritis Care and Research, vol. 70, no. 9, pp. 1294-1302. https://doi.org/10.1002/acr.23480
Barber, Megan R.W. ; Hanly, John G. ; Su, Li ; Urowitz, Murray B. ; St. Pierre, Yvan ; Romero-Diaz, Juanita ; Gordon, Caroline ; Bae, Sang Cheol ; Bernatsky, Sasha ; Wallace, Daniel J. ; Isenberg, David A. ; Rahman, Anisur ; Ginzler, Ellen M. ; Petri, Michelle ; Bruce, Ian N. ; Fortin, Paul R. ; Gladman, Dafna D. ; Sanchez-Guerrero, Jorge ; Ramsey-Goldman, Rosalind ; Khamashta, Munther A. ; Aranow, Cynthia ; Mackay, Meggan ; Alarcón, Graciela S. ; Manzi, Susan ; Nived, Ola ; Jönsen, Andreas ; Zoma, Asad A. ; van Vollenhoven, Ronald F. ; Ramos-Casals, Manuel ; Ruiz-Irastorza, Guillermo ; Lim, S. Sam ; Kalunian, Kenneth C. ; Inanc, Murat ; Kamen, Diane L. ; Peschken, Christine A. ; Jacobsen, Soren ; Askanase, Anca ; Theriault, Chris ; Farewell, Vernon ; Clarke, Ann E. / Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach. In: Arthritis Care and Research. 2018 ; Vol. 70, No. 9. pp. 1294-1302.
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abstract = "Objective: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. Methods: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. Results: A total of 1,545 patients participated; 89.3{\%} were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49{\%} were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4{\%} of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) <30 ml/minute ($310,579 2015 Canadian dollars versus $19,987 if no LN and estimated GFR >60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria <0.25 gm/day). Conclusion: Patients with estimated GFR <30 ml/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies.",
author = "Barber, {Megan R.W.} and Hanly, {John G.} and Li Su and Urowitz, {Murray B.} and {St. Pierre}, Yvan and Juanita Romero-Diaz and Caroline Gordon and Bae, {Sang Cheol} and Sasha Bernatsky and Wallace, {Daniel J.} and Isenberg, {David A.} and Anisur Rahman and Ginzler, {Ellen M.} and Michelle Petri and Bruce, {Ian N.} and Fortin, {Paul R.} and Gladman, {Dafna D.} and Jorge Sanchez-Guerrero and Rosalind Ramsey-Goldman and Khamashta, {Munther A.} and Cynthia Aranow and Meggan Mackay and Alarc{\'o}n, {Graciela S.} and Susan Manzi and Ola Nived and Andreas J{\"o}nsen and Zoma, {Asad A.} and {van Vollenhoven}, {Ronald F.} and Manuel Ramos-Casals and Guillermo Ruiz-Irastorza and Lim, {S. Sam} and Kalunian, {Kenneth C.} and Murat Inanc and Kamen, {Diane L.} and Peschken, {Christine A.} and Soren Jacobsen and Anca Askanase and Chris Theriault and Vernon Farewell and Clarke, {Ann E.}",
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TY - JOUR

T1 - Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach

AU - Barber, Megan R.W.

AU - Hanly, John G.

AU - Su, Li

AU - Urowitz, Murray B.

AU - St. Pierre, Yvan

AU - Romero-Diaz, Juanita

AU - Gordon, Caroline

AU - Bae, Sang Cheol

AU - Bernatsky, Sasha

AU - Wallace, Daniel J.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Ginzler, Ellen M.

AU - Petri, Michelle

AU - Bruce, Ian N.

AU - Fortin, Paul R.

AU - Gladman, Dafna D.

AU - Sanchez-Guerrero, Jorge

AU - Ramsey-Goldman, Rosalind

AU - Khamashta, Munther A.

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Alarcón, Graciela S.

AU - Manzi, Susan

AU - Nived, Ola

AU - Jönsen, Andreas

AU - Zoma, Asad A.

AU - van Vollenhoven, Ronald F.

AU - Ramos-Casals, Manuel

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S. Sam

AU - Kalunian, Kenneth C.

AU - Inanc, Murat

AU - Kamen, Diane L.

AU - Peschken, Christine A.

AU - Jacobsen, Soren

AU - Askanase, Anca

AU - Theriault, Chris

AU - Farewell, Vernon

AU - Clarke, Ann E.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objective: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. Methods: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. Results: A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) <30 ml/minute ($310,579 2015 Canadian dollars versus $19,987 if no LN and estimated GFR >60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria <0.25 gm/day). Conclusion: Patients with estimated GFR <30 ml/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies.

AB - Objective: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. Methods: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. Results: A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) <30 ml/minute ($310,579 2015 Canadian dollars versus $19,987 if no LN and estimated GFR >60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria <0.25 gm/day). Conclusion: Patients with estimated GFR <30 ml/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies.

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DO - 10.1002/acr.23480

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VL - 70

SP - 1294

EP - 1302

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