Systemic Lupus Erythematosus Severity Transitions and Related Impact on Health-Care Utilization and Costs

This study investigated the distribution of disease severity in patients with systemic lupus erythematosus (SLE), explored its impact on health-care resource utilization and costs, and evaluated SLE severity transitions over time.

SLE patients between 2015 and 2017 in Taiwan's National Health Insurance Research Database were retrospectively analyzed, and classified into the mild, moderate, or severe SLE groups. Annual health-care resource utilization, associated costs, lupus flare events, and severity transitions were analyzed.

A total of 20 181 patients with SLE were included, 29.3% of whom had mild, 60.7% had moderate, and 9.9% had severe SLE. Severity was correlated with health-care utilization and related costs, as well as the frequency and severity of flares. Patients with severe and moderate SLE incurred 2.18 and 1.42 times greater annual medical costs than those with mild SLE, respectively. Over the 2-year follow-up, the severe group experienced 13.23 flares, including 1.2 severe flares, significantly higher than those experienced by the moderate (9.38 flares, 0.34 severe flares) and mild (3.61 flares, 0.04 severe flares) SLE groups. Despite consistent severity distribution over 2 years, severity transitions occurred. Approximately 60% of severe patients improved within 1 year, 13% becoming mild. Conversely, fewer mild (2.8%-3.4%) and moderate (4.5%-5.4%) patients progressed to severe status annually.

This study offers insights into the distribution and transition patterns of SLE severity, and the correlation with health-care utilization, costs, and flare severity/frequency within a nationwide cohort. These findings highlight the importance of targeted interventions for controlling disease severity in SLE management.