The Impact of Systemic Lupus Erythematosus Flares on Clinical and Economic Outcomes: The CHAMOMILE Claims Database Study in Germany

INTRODUCTION

CHAMOMILE (CHaracteristics and impact of flares on clinicAl and econoMic OutcoMes In patients with systemic Lupus Erythematosus [SLE]) examined how flares in the year of SLE diagnosis impact future disease activity and damage, productivity, healthcare resource utilization (HCRU), and costs in patients with SLE in Germany.

METHODS

CHAMOMILE was a retrospective cohort study of adults with an SLE diagnosis in the German Sickness Fund Database from 1 July 2010 to 31 December 2013. Patients were classified according to their greatest flare severity during the baseline year (none, mild, or moderate/severe). The number and severity of flares were assessed annually over 5-8.5 follow-up years, along with SLE organ/system damage, treatments, work disability, and HCRU metrics.

RESULTS

Of 2088 patients (84.6% female; mean age [standard deviation] 51.4 [16.1] years; mean follow-up 6.8 [2.1] years), 34.3% (n = 716) were flare-free, 29.8% (n = 622) had mild flares, and 35.9% (n = 750) had moderate/severe flares at baseline. Baseline flare severity was related to future flares: rates during follow-up were higher in patients with moderate/severe baseline flares compared with those with mild or no baseline flares (89.6 vs 78.5 and 44.2 flares/100 patient years, respectively). Overall, 80.2% (n = 1675) of patients received glucocorticoids at least once during baseline and follow-up. Patients' HCRU was generally greatest in their baseline year. Costs were highest in patients with moderate/severe baseline flares.

CONCLUSION

Baseline flare severity provided insight into a patient's disease course and the clinical and economic burden of SLE over time, highlighting the ramifications of uncontrolled disease for patients with SLE.

POS1403 CLINICAL CHARACTERISTICS, HEALTH CARE RESOURCE UTILIZATION, AND COSTS ASSOCIATED WITH FLARES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN GERMANY

Background

Longitudinal data describing real-world systemic lupus erythematosus (SLE) disease characteristics, health care resource utilization (HCRU), and costs associated with flares in Germany are limited.

Objectives

To evaluate the clinical characteristics of patients with SLE and estimate the impact of flares on HCRU and costs in a cohort of adults with SLE in Germany.

Methods

CHaracteristics and impact of flares on clinicAl and econoMic OutcoMes In patients with systemic Lupus Erythematosus: a German Claims Database Study (CHAMOMILE) was an observational, retrospective cohort study. Adult patients with SLE were identified from the German Betriebskrankenkassen health insurance fund database between 1 July 2010 and 31 December 2013, and followed for up to 9 years. Baseline period was defined as the first year since the first quarter with the earliest SLE diagnosis during the identification period, including this quarter. Resource utilization measures included number of hospitalizations, duration of stay, and associated costs per person-year (PY) by follow-up year for patient subgroups defined by flare exposure (no, mild, or moderate/severe flares) during baseline. Cost measures included total PY costs in flare-exposure subgroups.

Results

Of 2088 patients included in the study, the mean (SD) age was 51.4 (16.1) years and 1767 (84.6%) were female. The most common SLE manifestations were cutaneous (66.8%), osteoarticular (28.7%), and vascular (23.0%). Patients were receiving treatment with glucocorticoids (54.8%), antimalarials (40.2%), nonsteroidal anti-inflammatory drugs (39.1%), and/or immunosuppressants (32.7%). During the baseline period, 750 patients (35.9%) experienced moderate/severe flares, 622 (29.8%) experienced mild flares, and 716 (34.3%) experienced no flares. Patients with no flares or mild flares during the baseline period had similar costs, and a similar number and duration of hospital stays per PY, which remained consistent from baseline up to 9 years of follow-up. Patients with moderate/severe flares during the baseline period had 2- to 3-fold higher hospital costs, 1- to 2-fold more hospital stays, and hospital stays that were 2-fold longer in duration, compared with the no-flares or mild-flares groups during baseline and each year of follow-up (Table 1). During the baseline period, annual total costs were more than 2-fold greater for patients with moderate/severe flares (€11,048/PY) than patients with mild (€5148/PY) or no flares (€4734/PY). In all subsequent years, costs for patients with moderate/severe flares exceeded costs for patients with mild or no flares. Annual total costs gradually increased over time to €7761/PY for patients with mild and to €7564/PY for patients with no flares at Year 9, whereas costs reduced sharply at follow-up Year 1 to €8801/PY and remained similar to Year 9 for patients with moderate/severe flares (Figure 1).

Table 1.

Mean Costs, Number, and Duration of Hospital Stays per Person-Year by Baseline Flares

Flare-Exposure SubgroupYearBaseline123456789Patients, nNo716716701676658634603526444315Mild622622613596575559534455348239Moderate/severe750750721690669646624503391263Costs of hospital stays, mean, €No1325179822961725223331261759178617952047Mild1779194415451820165222612390197422902451Moderate/severe5517355034032798272529992663369527142977Number of hospital stays, mean, nNo0.490.460.470.440.510.530.440.410.440.45Mild0.460.480.400.500.420.470.470.480.510.43Moderate/severe1.390.850.760.640.620.670.630.760.600.74Duration of hospital stays, mean, daysNo3.514.664.983.915.025.413.984.584.464.73Mild4.554.914.114.413.764.334.134.054.684.19Moderate/severe13.898.187.587.686.887.106.597.896.546.03

Conclusion

Patients with moderate or severe flares following diagnosis place a large burden on the health care system in Germany. Earlier diagnosis and treatment may reduce flare severity and the associated high health care costs.

Acknowledgements

Writing assistance by Rebecca S. Jones, PhD (Fishawack Health). This study was sponsored by AstraZeneca.

Disclosure of Interests

Bo Ding Employee of: AstraZeneca, Marc Pignot: None declared, Elena Garal-Pantaler: None declared, Beate Villinger Paid instructor for: Novartis, Vertex, Boehringer Ingelheim, UCB, Consultant of: Novartis, Vertex, Boehringer Ingelheim, UCB, AstraZeneca, Employee of: Novartis, AstraZeneca, Barnabas Desta Shareholder of: AstraZeneca, Employee of: AstraZeneca, Katharina Schmidt Employee of: AstraZeneca, Sarowar Golam Employee of: AstraZeneca, Heide Stirnadel-Farrant Shareholder of: AstraZeneca, GSK, Employee of: AstraZeneca, Andreas Schwarting Speakers bureau: AstraZeneca, Genentech, Consultant of: GSK, Astra Zeneca, Grant/research support from: GSK, Pfizer, Novartis