141 Cost effectiveness of a peer mentoring intervention to improve disease self-management practices and self-efficacy among African American women with systemic lupus erythematosus. (April 2019)

• Record Type: Journal Article
• Authors: Williams, Edith M; Dismuke, Clara; Faith, Trevor; Smalls, Brittany; Brown, Elizabeth; Oates, Jim; Egede, Leonard
• Is Part Of: Lupus science & medicine. Volume 6(2019)supplement 1
• Page Start: A102
• Page End: A103
• Publication Date: 2019-04
• Subjects: Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1136/lupus-2019-lsm.141
• Languages: English
• ISSNs: 2398-8851

Abstract

Abstract : Background: The annual medical costs for systemic lupus erythematosus (SLE) patients can reach up to $62 651 due to complex care needs. This presents a major challenge for all SLE patients, but it is compounded in African American women who experience the disease at a disproportionate rate and severity compared to other demographic cohorts. Peer mentoring interventions are one method examined in other chronic disease populations that has conferred self-management improvements for those patients. The Peer Approaches to Lupus Self-Management (PALS) is one such program, tailored for African American women with SLE, that could lead to cost-effective reductions in disease severity, flares, and subsequent resource utilization and medical costs. Methods: Validated measures of quality of life, disease self-management, disease activity, depression, and anxiety were collected pre- (0 weeks) and post- (12 weeks) intervention. Total direct program costs per-participant were totaled and used to determine average per-unit improvement in programmatic outcome measures. Additionally, the benefit cost ratio and pre- versus post- intervention hospital charges were examined. Results: Twenty mentees completed the study. Statistically significant reductions in disease activity, anxiety, and depression, were observed post-intervention. Patient self-management also improved, however did not reach statistical significance. Total cost per patient was $1, 882.83 or $91.14 per week. This yielded a cost benefit ratio of $3423 per 1 unit decrease in the Generalized Anxiety Disorder score, $818 per 1 unit decrease in the PHQ-8 (depression) score, and $85.74 per 1 unit decrease in the SLAQ (disease activity) score. There was a statistically significant difference in pre-intervention hospital charges ($24, 289, 95% CI: $55, $48, 524) and post- hospital charges ($872, 95% CI: -$324, $2, 070) (p=0.047), representing a substantial mean charge savings of $23 426 per individual. The benefit cost ratio was 12.44 per patient which implies that benefits were over 12 times higher than the cost per patient. Conclusions: These findings indicate that the PALS intervention was not only effective in improving patient-level factors such as depression, anxiety, and self-reported disease activity, but the program was also highly cost-effective. These findings suggest that if adopted on a larger scale, this approach could significantly reduce financial burden on patients and medical facilities, as well as improve the quality of life of a high-risk patient population. Future research will need to validate these findings in a larger sample. Funding Source(s): This project was supported by NIH/NCATS Grant Number UL1, the Rheumatology and Immunology MCRC NIH/NIAMS Grant Number AR062755, NIH/NIAMS K23 AR052364, and NIH/NCRR UL1 RR029882.