The mean direct cost for treating childhood-onset systemic lupus erythematosus per patient is $14,944 a year, which is roughly three times higher than the cost of treating an adult with the condition, results from the first analysis of its kind demonstrated.
“Whether this difference in cost between adults and children is due to differences in health care delivery systems, adherence to therapies, or differences in disease severity remains to be determined,” wrote the researchers, led by Dr. Hermine I. Brunner of the division of rheumatology at Cincinnati Children's Hospital Medical Center.
The researchers reviewed the clinical and administrative records of 119 patients with childhood-onset systemic lupus erythematosus (cSLE) who were diagnosed and treated at two large tertiary pediatric rheumatology centers in the United States between January 2001 and April 2004 (Arthritis & Rheum. 2006;55:184–8). They used health-related quality of life estimates for patients with cSLE as reported in the medical literature to calculate the direct cost per quality-adjusted life-year. These quality of life measures were based on the global health subscale of the Child Health Questionnaire.
Of the 119 patients, 87% were female. The mean duration of follow-up was 27 months, and the researchers reported on results of 3,184 patient-months of follow-up.
The cumulative cost of medical care during the study period was $3,965,048, which excluded the cost of outpatient medications. This translated into a mean per-patient monthly cost of $1,245, or $14,944 per year. In contrast, recent estimates of the per-patient annual cost of treating adult SLE put the figure at $4,170.
A breakdown of the direct costs revealed that most came from inpatient or day-patient care (28%), followed by laboratory testing (21%), inpatient or day-patient medication (13%), dialysis (11%), and outpatient clinic visits other than rheumatology outpatient visits (11%).
The researchers noted that only 3 of the 199 patients required dialysis, yet it was the fourth-largest cost entity. “Therefore, based on previous research in adults, dialysis expenses contribute to the direct cost of both SLE and cSLE in similar proportions,” they wrote.
“This finding suggests that prevention and aggressive therapy of renal diseases are not only of utmost importance for avoiding patient damage but also appear to be relevant for containing the cost of care of cSLE,” they noted.
The study was supported by the Robert Wood Johnson Foundation, the Arthritis Foundation of America, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.