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Published on: November 1, 2015
Direct medical charges in a population-based systemic lupus erythematosus cohort
Daniel Bao1, Cristina Drenkard2, Charmayne Dunlop-Thomas2
1Duke University, Durham, NC, USA.
Insights
Systemic Lupus Erythematosus (SLE) hospitalizations and emergency visits incur significant direct medical charges, particularly for vulnerable populations. Addressing social determinants of health is crucial for reducing the economic burden of SLE.
Area of Science:
- Rheumatology
- Health Economics
- Public Health
Background:
- Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with significant healthcare utilization.
- Understanding the direct medical costs associated with SLE hospitalizations and emergency visits is essential for resource allocation and policy development.
- The Georgians Organized Against Lupus (GOAL) cohort provides a diverse population for studying SLE outcomes and associated healthcare charges.
Purpose of the Study:
- To estimate the direct medical charges for hospitalizations and emergency department visits among a diverse population of Systemic Lupus Erythematosus (SLE) cases.
- To analyze the impact of social determinants of health (SDoH) on healthcare utilization and associated costs in SLE patients.
- To identify factors contributing to the economic burden of SLE in a real-world, population-based cohort.
Main Methods:
- Utilized survey data from the GOAL cohort (2011-2012) linked to the Georgia Hospital Discharge Database (2012-2013).
- Captured hospital admissions (HAs) and emergency department visits (EDVs) for validated SLE cases.
- Summarized direct medical charges by healthcare utilization type, socio-demographics, and healthcare factors.
Main Results:
- Among 829 SLE patients, 20.5% had hospitalizations and 36.2% had emergency visits within a year.
- Average per-patient direct medical charges were $14,968 for HAs and $3,022 for EDVs.
- Higher social vulnerability and disease severity were associated with increased charges for both HAs and EDVs (p < 0.01).
Conclusions:
- The study highlights the substantial economic burden of SLE, especially on vulnerable populations.
- Socio-economic factors significantly influence healthcare costs in SLE patients, underscoring the need for their inclusion in healthcare planning.
- Policy interventions should focus on reducing healthcare access disparities and promoting preventive strategies for SLE management.
Aim:
This study aimed to obtain estimates for the direct medical charges associated with hospitalizations and emergency department visits of validated SLE cases in a diverse Systemic Lupus Erythematosus (SLE) population.
Methods:
The Georgians Organized Against Lupus (GOAL) cohort is a population-based cohort of adult SLE patients from metropolitan Atlanta, GA USA, an area having a diverse SLE population. The GOAL cohort aims to study the impact of social determinants of health (SDoH) on outcomes relevant to patients, healthcare providers, and policymakers. For this study, survey data collected during 2011-2012 was linked to the Georgia Hospital Discharge Database (HDD) to capture hospital admissions (HAs) and emergency department visits (EDVs) throughout Georgia from 2012 through 2013. Direct medical charges were summarized by HCU type among all patients, among those with actual visits, and by socio-demographics and healthcare factors.
Results:
Among 829 patients (94% women, 78% Black, 64% non-private insurance, 64% not-employed, mean age of 46), 170 (20.5%) and 300 (36.2%) participants had at least one HA and one EDV in 1-year of follow-up, respectively, with 111(13.4%) having both HA and EDV. On average, each patient experienced 0.38 HAs and 0.91 EDVs, with per-patient direct medical charges of $14,968 for HAs & $3,022 for EDVs, and $39,645 per HA & $3,305 per EDV. Patients with higher social vulnerability or more severe disease had higher charges for both HA and EDV (p < 0.01), likely due to the delayed care and neglected health needs leading to more advanced and costly medical treatments. Living below the federal poverty level was associated with higher charges for EDVs (p < 0.001) but with lower charges for HAs (p = 0.036).
Conclusions:
This study underscores the economic burden of SLE on vulnerable populations, emphasizing the importance of including socio-economic factors in healthcare planning. Policy efforts should prioritize reducing disparities in access to care and implementing preventive strategies.
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