Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling

Ann E. Clarke; John G. Hanly; Murray B. Urowitz; Yvan St. Pierre; Caroline Gordon; Sang Cheol Bae; Juanita Romero-Diaz; Jorge Sanchez-Guerrero; Sasha Bernatsky; Daniel J. Wallace; David A. Isenberg; Anisur Rahman; Joan T. Merrill; Paul R. Fortin; Dafna D. Gladman; Ian N. Bruce; Michelle Petri; Ellen M. Ginzler; Mary Anne Dooley; Rosalind Ramsey-Goldman; Susan Manzi; Andreas Jönsen; Graciela S. Alarcón; Ronald F. Van Vollenhoven; Cynthia Aranow; Meggan Mackay; Guillermo Ruiz-Irastorza; S. Sam Lim; Murat Inanc; Kenneth C. Kalunian; Soren Jacobsen; Christine A. Peschken; Diane L. Kamen; Anca Askanase; Vernon Farewell

doi:10.1002/acr.25090

Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling

Ann E. Clarke^*, John G. Hanly, Murray B. Urowitz, Yvan St. Pierre, Caroline Gordon, Sang Cheol Bae, Juanita Romero-Diaz, Jorge Sanchez-Guerrero, Sasha Bernatsky, Daniel J. Wallace, David A. Isenberg, Anisur Rahman, Joan T. Merrill, Paul R. Fortin, Dafna D. Gladman, Ian N. Bruce, Michelle Petri, Ellen M. Ginzler, Mary Anne Dooley, Rosalind Ramsey-GoldmanSusan Manzi, Andreas Jönsen, Graciela S. Alarcón, Ronald F. Van Vollenhoven, Cynthia Aranow, Meggan Mackay, Guillermo Ruiz-Irastorza, S. Sam Lim, Murat Inanc, Kenneth C. Kalunian, Soren Jacobsen, Christine A. Peschken, Diane L. Kamen, Anca Askanase, Vernon Farewell

^*Corresponding author for this work

Medicine, Rheumatology Division

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. Methods: NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. Results: A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Conclusion: Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.

Original language	English (US)
Pages (from-to)	1859-1870
Number of pages	12
Journal	Arthritis Care and Research
Volume	75
Issue number	9
DOIs	https://doi.org/10.1002/acr.25090
State	Published - Sep 2023

Funding

The Systemic Lupus International Collaborating Clinics research network received partial funding for this study from UCB Pharmaceuticals. The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. The Hopkins Lupus Cohort is supported by the NIH (grants AR‐43727 and AR‐69572). Dr. Clarke holds the Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Hanly's work was supported by the Canadian Institutes of Health Research (grant MOP‐88526). Dr. Gordon's work was supported by Lupus UK, Sandwell and West Birmingham Hospitals NHS Trust, and the Birmingham NIHR/Wellcome Trust Clinical Research Facility. Dr. Bae's work was supported in part by the National Research Foundation of Korea, funded by the Ministry of Education (grant NRF‐2021R1A6A1A03038899). Dr. Bernatsky holds a James McGill Research Chair. Drs. Isenberg and Rahman's work was supported by the NIHR University College London Hospitals Biomedical Research Center. Dr. Fortin holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval. Dr. Bruce's work was supported by Versus Arthritis UK, the NIHR Manchester Biomedical Research Centre, and the NIHR Manchester Clinical Research Facility. Dr. Dooley's work was supported by the NIH (grant RR‐00046). Dr. Ramsey‐Goldman's work was supported by the NIH (grants 5UL1‐TR‐001422‐02 [formerly 8UL1‐TR‐000150 and UL1‐RR‐025741], K24‐AR‐02318, and P30‐AR‐072579 [formerly P60‐AR‐064464 and P60‐AR‐48098]). Dr. Ruiz‐Irastorza's work was supported by the Department of Education, Universities, and Research of the Basque Government. Dr. Jacobsen's work was supported by the Danish Rheumatism Association (grant A3865) and the Independent Research Fund Denmark (grant 0134‐00473B).

ASJC Scopus subject areas

Rheumatology

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10.1002/acr.25090

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Clarke, A. E., Hanly, J. G., Urowitz, M. B., St. Pierre, Y., Gordon, C., Bae, S. C., Romero-Diaz, J., Sanchez-Guerrero, J., Bernatsky, S., Wallace, D. J., Isenberg, D. A., Rahman, A., Merrill, J. T., Fortin, P. R., Gladman, D. D., Bruce, I. N., Petri, M., Ginzler, E. M., Dooley, M. A., ... Farewell, V. (2023). Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling. Arthritis Care and Research, 75(9), 1859-1870. https://doi.org/10.1002/acr.25090

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title = "Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling",

abstract = "Objective: To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. Methods: NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. Results: A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Conclusion: Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.",

author = "Clarke, {Ann E.} and Hanly, {John G.} and Urowitz, {Murray B.} and {St. Pierre}, Yvan and Caroline Gordon and Bae, {Sang Cheol} and Juanita Romero-Diaz and Jorge Sanchez-Guerrero and Sasha Bernatsky and Wallace, {Daniel J.} and Isenberg, {David A.} and Anisur Rahman and Merrill, {Joan T.} and Fortin, {Paul R.} and Gladman, {Dafna D.} and Bruce, {Ian N.} and Michelle Petri and Ginzler, {Ellen M.} and Dooley, {Mary Anne} and Rosalind Ramsey-Goldman and Susan Manzi and Andreas J{\"o}nsen and Alarc{\'o}n, {Graciela S.} and {Van Vollenhoven}, {Ronald F.} and Cynthia Aranow and Meggan Mackay and Guillermo Ruiz-Irastorza and Lim, {S. Sam} and Murat Inanc and Kalunian, {Kenneth C.} and Soren Jacobsen and Peschken, {Christine A.} and Kamen, {Diane L.} and Anca Askanase and Vernon Farewell",

note = "Publisher Copyright: {\textcopyright} 2023 American College of Rheumatology.",

year = "2023",

month = sep,

doi = "10.1002/acr.25090",

language = "English (US)",

volume = "75",

pages = "1859--1870",

journal = "Arthritis Care and Research",

issn = "2151-464X",

publisher = "John Wiley & Sons Inc.",

number = "9",

}

Clarke, AE, Hanly, JG, Urowitz, MB, St. Pierre, Y, Gordon, C, Bae, SC, Romero-Diaz, J, Sanchez-Guerrero, J, Bernatsky, S, Wallace, DJ, Isenberg, DA, Rahman, A, Merrill, JT, Fortin, PR, Gladman, DD, Bruce, IN, Petri, M, Ginzler, EM, Dooley, MA, Ramsey-Goldman, R, Manzi, S, Jönsen, A, Alarcón, GS, Van Vollenhoven, RF, Aranow, C, Mackay, M, Ruiz-Irastorza, G, Lim, SS, Inanc, M, Kalunian, KC, Jacobsen, S, Peschken, CA, Kamen, DL, Askanase, A & Farewell, V 2023, 'Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling', Arthritis Care and Research, vol. 75, no. 9, pp. 1859-1870. https://doi.org/10.1002/acr.25090

TY - JOUR

T1 - Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling

AU - Clarke, Ann E.

AU - Hanly, John G.

AU - Urowitz, Murray B.

AU - St. Pierre, Yvan

AU - Gordon, Caroline

AU - Bae, Sang Cheol

AU - Romero-Diaz, Juanita

AU - Sanchez-Guerrero, Jorge

AU - Bernatsky, Sasha

AU - Wallace, Daniel J.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Merrill, Joan T.

AU - Fortin, Paul R.

AU - Gladman, Dafna D.

AU - Bruce, Ian N.

AU - Petri, Michelle

AU - Ginzler, Ellen M.

AU - Dooley, Mary Anne

AU - Ramsey-Goldman, Rosalind

AU - Manzi, Susan

AU - Jönsen, Andreas

AU - Alarcón, Graciela S.

AU - Van Vollenhoven, Ronald F.

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S. Sam

AU - Inanc, Murat

AU - Kalunian, Kenneth C.

AU - Jacobsen, Soren

AU - Peschken, Christine A.

AU - Kamen, Diane L.

AU - Askanase, Anca

AU - Farewell, Vernon

PY - 2023/9

Y1 - 2023/9

N2 - Objective: To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. Methods: NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. Results: A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Conclusion: Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.

AB - Objective: To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. Methods: NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. Results: A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Conclusion: Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.

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Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling

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