TY - JOUR
T1 - Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling
AU - Clarke, Ann E.
AU - Hanly, John G.
AU - Urowitz, Murray B.
AU - St. Pierre, Yvan
AU - Gordon, Caroline
AU - Bae, Sang-Cheol
AU - Romero-Diaz, Juanita
AU - Sanchez-Guerrero, Jorge
AU - Bernatsky, Sasha
AU - Wallace, Daniel J.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Merrill, Joan T.
AU - Fortin, Paul R.
AU - Gladman, Dafna D.
AU - Bruce, Ian N.
AU - Petri, Michelle
AU - Ginzler, Ellen M.
AU - Dooley, Mary Anne
AU - Ramsey-Goldman, Rosalind
AU - Manzi, Susan
AU - Jönsen, Andreas
AU - Alarcón, Graciela S.
AU - van Vollenhoven, Ronald F.
AU - Aranow, Cynthia
AU - Mackay, Meggan
AU - Ruiz-Irastorza, Guillermo
AU - Lim, S. Sam
AU - Inanc, Murat
AU - Kalunian, Kenneth C.
AU - Jacobsen, Soren
AU - Peschken, Christine A.
AU - Kamen, Diane L.
AU - Askanase, Anca
AU - Farewell, Vernon
N1 - Funding Information:
The Systemic Lupus International Collaborating Clinics research network received partial funding for this study from UCB Pharmaceuticals. The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. The Hopkins Lupus Cohort is supported by the NIH (grants AR‐43727 and AR‐69572). Dr. Clarke holds the Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Hanly's work was supported by the Canadian Institutes of Health Research (grant MOP‐88526). Dr. Gordon's work was supported by Lupus UK, Sandwell and West Birmingham Hospitals NHS Trust, and the Birmingham NIHR/Wellcome Trust Clinical Research Facility. Dr. Bae's work was supported in part by the National Research Foundation of Korea, funded by the Ministry of Education (grant NRF‐2021R1A6A1A03038899). Dr. Bernatsky holds a James McGill Research Chair. Drs. Isenberg and Rahman's work was supported by the NIHR University College London Hospitals Biomedical Research Center. Dr. Fortin holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval. Dr. Bruce's work was supported by Versus Arthritis UK, the NIHR Manchester Biomedical Research Centre, and the NIHR Manchester Clinical Research Facility. Dr. Dooley's work was supported by the NIH (grant RR‐00046). Dr. Ramsey‐Goldman's work was supported by the NIH (grants 5UL1‐TR‐001422‐02 [formerly 8UL1‐TR‐000150 and UL1‐RR‐025741], K24‐AR‐02318, and P30‐AR‐072579 [formerly P60‐AR‐064464 and P60‐AR‐48098]). Dr. Ruiz‐Irastorza's work was supported by the Department of Education, Universities, and Research of the Basque Government. Dr. Jacobsen's work was supported by the Danish Rheumatism Association (grant A3865) and the Independent Research Fund Denmark (grant 0134‐00473B).
Publisher Copyright:
© 2023 American College of Rheumatology.
PY - 2023/9
Y1 - 2023/9
N2 - Objective: To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. Methods: NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. Results: A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Conclusion: Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.
AB - Objective: To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. Methods: NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. Results: A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Conclusion: Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.
UR - https://www.scopus.com/pages/publications/85148597344
U2 - 10.1002/acr.25090
DO - 10.1002/acr.25090
M3 - Article
C2 - 36691838
SN - 2151-464X
VL - 75
SP - 1859
EP - 1870
JO - Arthritis care and research
JF - Arthritis care and research
IS - 9
ER -
SDG 3 Good Health and Well-being