Economic burden of systemic lupus erythematosus and lupus nephritis in France: a nationwide population-based study using the French medico-administrative (SNDS) claims database.

Objectives: Data on the economic consequences of systemic lupus erythematosus (SLE) and lupus nephritis (LN) are scarce in Europe. We aimed to estimate the total direct costs attributable to SLE and LN in France, at the nationwide level.

Methods: Patients with SLE and LN were identified in the French nationwide health insurance database (SNDS). Prevalent SLE patients for the year 2019 were age- and sex-matched (1:1) with non-SLE controls. Direct costs (in 2019 euros) were assigned from a societal and a third-party payer perspective, using official sources.

Results: A total of 29,135 SLE patients, including 4357 (14.5%) with lupus nephritis, were matched to non-SLE controls. The median overall direct cost for SLE was €4795 versus €1910 for controls from a third-party payer perspective (P<0.0001). From a societal perspective the overall direct cost of SLE patients was higher (€5894) compared to non-SLE matched controls (€2601, P<0.0001), for hospitalizations (+€1305 versus non-SLE controls), medications (+€872), consultations (+€343) and transportation (+€193). The overall median cost for LN was €9800 versus €3918 for SLE patients without LN, from third-party payer perspective, and €11,279 versus €4950 from a societal perspective (P<0.0001, for both). At a national level, the extra cost of SLE compared to non-SLE controls was M€104.9 with hospitalizations contributing to 39.6% of this extra cost.

Conclusions: The direct extra costs of SLE and LN are substantial in France, particularly for hospitalizations, outpatient medications, consultations, and transportations. By identifying and addressing major drivers of SLE costs, healthcare providers and policymakers can work towards more cost-effective strategies for managing SLE.