THE ECONOMIC-IMPACT OF TREATMENT OF SEVERE LUPUS NEPHRITIS WITH PREDNISONE AND INTRAVENOUS CYCLOPHOSPHAMIDE

Objective. It has been reported that outcomes are improved in patients with severe lupus nephritis treated with combined prednisone and intr avenous cyclophosphamide, compared with those treated with prednisone alone. These findings motivated this analysis of the economic impact o f the combined therapy. Methods. The annual expected incidence of seve re lupus nephritis in the year 1988 in the US was estimated to be 1,13 0. A hypothetical patient cohort of this size was used as the model fo r the present analysis; the costs of treatment with prednisone alone a nd with combined prednisone and intravenous cyclophosphamide were calc ulated and compared. The analysis took into account the expected rate of renal failure with each therapeutic approach, as well as age, sex, and the economic value of working years gained. Results. Although the treatment costs are higher for the combination therapy, the analysis r evealed overall savings due to a reduced need for kidney dialysis or t ransplantation, acid the economic value of working capacity gained. Sa vings attributable to patient care costs were $50.8 million; those att ributable to working capacity gained were $42.3 million. Conclusion. T his analysis indicates that over a l0-year period, as much as $93.1 mi llion per annual cohort is saved by the use of combination therapy for the treatment of severe lupus nephritis.