Economic evaluation of lupus nephritis and
damage accrual in the SLICC inception cohort

New Investigators: Dr. Megan Barber (Rheumatology Fellow, University of Calgary); Dr. May Choi (Rheumatology Fellow, University of Calgary)
Funding Source: UCB, Bristol-Myers Squibb

The objectives of this study are to estimate the long-term economic costs of: 1) lupus nephritis (LN) and
2) damage accrual based on models developed through analysis of longitudinal data from the Systemic
Lupus International Collaborating Clinics (SLICC) international inception cohort database.

We have shown that patients with LN and severe impairment in renal function incurred 10-year direct costs
(i.e., health services used) 15-fold higher than those with no LN and normal renal function. By
estimating the expected duration in each renal state and incorporating associated annual costs, disease
severity at presentation can be used to anticipate future healthcare costs. This is critical knowledge
for cost-effectiveness evaluations of novel therapies.

We have also shown that patients with the highest baseline scores on the SLICC/ACR Damage Index (SDI)
incurred 10-year direct costs approximately 4-fold higher than those with the lowest SDIs. However,
indirect costs (i.e., lost productivity) did not vary much with SDI and were influenced by other factors
(potentially disease activity, quality of life, fatigue, plateauing of expectations regarding
productivity later in the disease) and patients incurred considerable indirect costs even with no or
minimal damage. This work demonstrates the cost savings potentially achieved by earlier introduction of
therapies more effective at attenuating damage progression and the need for interventions targeted at
improving employment outcomes.


  • 1.Barber MRW, Hanly JG, Su L, Urowitz MB, St Pierre Y, Romero-Diaz J, Gordon C,
     Bae SC, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Fortin
    PR, Gladman DD,  Sanchez-Guerrero J, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón
    GS, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G,
    Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Theriault C, 
    Farewell V,  Clarke AE. Economic evaluation of lupus nephritis in the Systemic Lupus
    International Collaborating Clinics inception cohort using a multistate model approach.
    Arthritis Care and Research. In Press.

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