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

Megan R W Barber¹, John G Hanly², Li Su³, Murray B Urowitz⁴, Yvan St Pierre⁵, Juanita Romero-Diaz⁶, Caroline Gordon⁷, Sang-Cheol Bae⁸, Sasha Bernatsky⁹, Daniel J Wallace¹⁰, David A Isenberg¹¹, Anisur Rahman¹¹, Ellen M Ginzler¹², Michelle Petri¹³, Ian N Bruce¹⁴, Paul R Fortin¹⁵, Dafna D Gladman⁴, Jorge Sanchez-Guerrero⁴, Rosalind Ramsey-Goldman¹⁶, Munther A Khamashta¹⁷, Cynthia Aranow¹⁸, Meggan Mackay¹⁸, Graciela S Alarcón¹⁹, Susan Manzi²⁰, Ola Nived²¹, Andreas Jönsen²¹, Asad A Zoma²², Ronald F van Vollenhoven²³, Manuel Ramos-Casals²⁴, Guillermo Ruiz-Irastorza²⁵, S Sam Lim²⁶, Kenneth C Kalunian²⁷, Murat Inanc²⁸, Diane L Kamen²⁹, Christine A Peschken³⁰, Soren Jacobsen³¹, Anca Askanase³², Chris Theriault², Vernon Farewell³, Ann E Clarke¹

Affiliations

¹ University of Calgary, Alberta, Canada.
² Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
³ MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
⁴ Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
⁵ Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
⁶ Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
⁷ Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁸ Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
⁹ McGill University Health Centre, Montreal, Quebec, Canada.
¹⁰ Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles.
¹¹ University College London, London, UK.
¹² State University of New York Downstate Medical Center, Brooklyn, New York.
¹³ Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁴ Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, the University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
¹⁵ CHU de Québec-Université Laval, Quebec City, Canada.
¹⁶ Northwestern University and Feinberg School of Medicine, Chicago, Illinois.
¹⁷ Lupus Research Unit, The Rayne Institute, St Thomas's Hospital, King's College London School of Medicine, London, UK.
¹⁸ Feinstein Institute for Medical Research, Manhasset, New York.
¹⁹ University of Alabama at Birmingham.
²⁰ University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
²¹ Lund University, Lund, Sweden.
²² Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
²³ Karolinska Institute, Stockholm, Sweden.
²⁴ Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
²⁵ BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
²⁶ Emory University School of Medicine, Atlanta, Georgia.
²⁷ University of California Los Angeles School of Medicine, La Jolla.
²⁸ Istanbul University, Istanbul, Turkey.
²⁹ Medical University of South Carolina, Charleston.
³⁰ University of Manitoba, Winnipeg, Manitoba, Canada.
³¹ Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
³² Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York.

PMID: 29193883
PMCID: PMC6155450
DOI: 10.1002/acr.23480

Multicenter Study

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

Megan R W Barber et al. Arthritis Care Res (Hoboken). 2018 Sep.

. 2018 Sep;70(9):1294-1302.

doi: 10.1002/acr.23480. Epub 2018 Aug 17.

Authors

Affiliations

¹ University of Calgary, Alberta, Canada.
² Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
³ MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
⁴ Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
⁵ Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
⁶ Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
⁷ Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁸ Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
⁹ McGill University Health Centre, Montreal, Quebec, Canada.
¹⁰ Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles.
¹¹ University College London, London, UK.
¹² State University of New York Downstate Medical Center, Brooklyn, New York.
¹³ Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁴ Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, the University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
¹⁵ CHU de Québec-Université Laval, Quebec City, Canada.
¹⁶ Northwestern University and Feinberg School of Medicine, Chicago, Illinois.
¹⁷ Lupus Research Unit, The Rayne Institute, St Thomas's Hospital, King's College London School of Medicine, London, UK.
¹⁸ Feinstein Institute for Medical Research, Manhasset, New York.
¹⁹ University of Alabama at Birmingham.
²⁰ University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
²¹ Lund University, Lund, Sweden.
²² Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
²³ Karolinska Institute, Stockholm, Sweden.
²⁴ Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
²⁵ BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
²⁶ Emory University School of Medicine, Atlanta, Georgia.
²⁷ University of California Los Angeles School of Medicine, La Jolla.
²⁸ Istanbul University, Istanbul, Turkey.
²⁹ Medical University of South Carolina, Charleston.
³⁰ University of Manitoba, Winnipeg, Manitoba, Canada.
³¹ Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
³² Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York.

PMID: 29193883
PMCID: PMC6155450
DOI: 10.1002/acr.23480

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.

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Figures

**Figure 1. Multstate Markov model for observed transitions between estimated glomerular filtration rate (eGFR) and estimated proteinuria (ePrU) states**
eGFR: state 1 > 60 mL/min, state 2 30 – 60 mL/min, state 3 < 30 mL/min ePrU: state 1 < 0.25 g/d, state 2 0.25 – 3.0 g/d, state 3 > 3.0 g/d

See this image and copyright information in PMC

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

Affiliations

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

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources