Incremental direct medical costs of systemic lupus erythematosus patients in the years preceding diagnosis: A general population-based study.

Objective We estimated the incremental (extra) direct medical costs of a population-based cohort of newly diagnosed systemic lupus erythematosus (SLE) for five years before and after diagnosis, and the impact of sex and socioeconomic status (SES) on pre-index costs for SLE. Methods We identified all adults newly diagnosed with SLE over 2001-2010 in British Columbia, Canada, and obtained a sample of non-SLE individuals from the general population, matched on sex, age, and calendar-year of study entry. We captured costs for all outpatient encounters, hospitalisations, and dispensed medications each year. Using generalised linear models, we estimated incremental costs of SLE each year before/after diagnosis (difference in costs between SLE and non-SLE, controlling for covariates). Similar models were used to examine the impact of sex and SES on costs within SLE. Results We included 3632 newly diagnosed SLE (86% female, mean age 49.6 ± 15.9) and 18,060 non-SLE individuals. Over the five years leading up to diagnosis, per-person healthcare costs for SLE patients increased year-over-year by 35%, on average, with the biggest increases in the final two years by 39% and 97%, respectively. Per-person all-cause medical costs for SLE the year after diagnosis (Year + 1) averaged C$12,019 (2013 Canadian) with 58% from hospitalisations, 24% outpatient, and 18% from prescription medications; Year + 1 costs for non-SLE averaged C$2412. Following adjustment for age, sex, urban/rural residence, socioeconomic status, and prior year's comorbidity score, SLE was associated with significantly greater hospitalisation, outpatient, and medication costs than non-SLE in each year of study. Altogether, adjusted incremental costs of SLE rose from C$1131 per person in Year -5 (fifth year before diagnosis) to C$2015 (Year -2), C$3473 (Year -1) and C$6474 (Year + 1). In Years -2, -1 and +1, SLE patients in the lowest SES group had significantly greater costs than the highest SES. Unlike the non-SLE cohort, male patients with SLE had higher costs than females. Annual incremental costs of SLE males (vs. SLE females) rose from C$540 per person in Year -2, to C$1385 in Year -1, and C$2288 in Year + 1. Conclusion Even years before diagnosis, SLE patients incur significantly elevated direct medical costs compared with the age- and sex-matched general population, for hospitalisations, outpatient care, and medications.

Health care cost savings from Australian Poisons Information Centre advice for low risk exposure calls: SNAPSHOT 2.

Introduction: To estimate cost savings from the Australian Poisons Information Centres (PIC) through reductions in unnecessary health resources following unintentional low toxicity poisonings.Methods: Two telephone surveys were conducted. The first to PIC callers over a one-week period about unintentional exposures where the callers' alternate course of action in the hypothetical situation in which the PIC did not exist was questioned. The second survey to determine the proportion of callers followed PIC advice. We estimated cost savings associated with instances where individuals acted on advice not to present to hospital, when they indicated they would have otherwise as well as savings from preventing unnecessarily utilisation of medical resources. Database records of unintentional poisonings from all Australian PICs for 2017 were used.Results: A total of 958 consecutive callers were surveyed. PIC advised 91% of callers to stay at home, remaining callers were referred to hospital (5%), to their GP (3%) or given other recommended management advice (1%). PIC advice was followed by 97.6% of callers. In PIC absence, 22% of callers who were advised to stay home would have presented to hospital (3% via ambulance), 8% would visit their General Practitioner (GP) and only 9% would stay at home. In 2017, PICs were called about 94,913 unintentional poisonings; and PICs generated at least $10.1 million in annual savings.Conclusion: In 2017, PICs provided at least a three-fold return on investment for every dollar invested, demonstrating that PICs are a highly cost effective service.