May. 16, 2016

Reducing Steroids Associated with Lower Healthcare Costs in Lupus Treatment

Steroids are used to reduce inflammation caused by lupus. However, using steroids can cause numerous side effects. Risks such as fluid retention, fragile skin, infection, heart disease and osteoporosis, are compelling reasons for limiting exposure to steroids, when possible. A new study suggests that cost savings may be another important reason for developing therapies that reduce the need for steroids for lupus treatment.

This study, published in Arthritis Care & Research, is the first large-scale study to document a relationship between the duration of steroid use and the cost and use of health care resources among adults with lupus. This study adds to a growing body of research that suggests that decreasing steroid treatment may reduce health care costs for individuals with lupus.

Here's what lead author, Dr. Shih-Yin Chen, Associate Director at Biogen, had to say about the study:

What was the purpose of your study and why is it important?

The purpose of this study was to understand the relationship between health care costs and steroid use in adults with lupus. It is important to understand this relationship because steroids can cause a wide range of adverse events (undesirable experiences associated with the use of a medical product), which require substantial and potentially costly health care resources. Understanding this relationship can help us recognize the relative value of potential therapies that may help reduce the need for steroids.

What are the major findings of the study?

Using a large health insurance database between 2007 and 2011, we analyzed data from approximately 50,000 lupus patients between 18 and 64 years of age. The study showed that annual total health care costs for lupus patients averaged $21,000. Half of the patients used oral steroids. We found that lupus patients who used steroids at a higher average daily dose were associated with higher health care costs.

Is this new information?

To our knowledge, this was the first large-scale study to document the relationship between steroid dose and duration with the use and costs of health care resources.

Why might individuals who used low-dose steroids and immunosuppressants (medications that suppress the immune system) have lower health care costs compared to those who used low-dose steroids but did not use immunosuppressants?

We analyzed the relationship between steroid dose and health care costs in two subgroups: individuals who used low-dose steroids and immunosuppressants (an indication of more severe lupus disease) and individuals who used low-dose steroids but who not did not use immunosuppressants (an indication of less severe lupus disease). We found that although patients in both groups who used low-dose steroids had higher costs compared with those who did not use steroids, the cost increase was less among those who also used immunosuppressants.

One hypothesis is that immunosuppressants may be able to successfully reduce the need for steroid use and have economic benefits. However, this study did not provide a definitive explanation. We recommend further research to explore the effect and benefit of steroid-sparing therapies.

What do the results of your study mean for people with lupus?

We found that patients who were taking higher steroid dosages incurred more health care costs. However, we have not yet determined the factors driving this relationship. We hope the association demonstrated by our study will encourage additional research to better understand and design interventions for lupus patients that may reduce steroid exposure and health care costs.

Are more studies planned on this topic?

We are considering other study designs to further explore the questions not answered by this study.

What are this study’s limitations?

The main limitation of this study was that the data did not provide clinical details related to lupus disease severity, which could also influence health care costs. We also were unable to determine the reasons for the relationship observed betwee