OBJECTIVES: To describe the economic burden of SLE, including direct costs, indirect costs and healthcare resource utilization (HCRU).

METHODS: We systematically searched Embase®, MEDLINE®, EconLit, and NHSEED databases from inception to July 8, 2022 for English-language observational studies reporting on economic burden among adult SLE patients from US, EU5, China, and Japan.

RESULTS: Of 3,807 records screened, 92 primary studies were included, spanning across US (number of studies, N=71), multi-national [including US, France, Germany, Spain, UK and others (N=8)], Germany (N=5), UK (N=4), and individual studies from: France, Spain, China, and Japan. Sixty-two studies reported direct costs, of which twenty-eight studies reported annual total direct cost (TDC). Costs expressed as annual TDC per patient (pp) ranged from $5,133 to $71,758 (median $23,801) across US, €3,067 (at baseline) to €5,929 (median €3,191) across Germany, and €3,163 to €7,532 (median €6,114) across UK. Annual TDC pp was €4,156 and €6,065 across Spain, €4,003 across France, and ¥1,017,012 across Japan. Patients with moderate to severe SLE exhibited higher annual mean TDC compared to those with mild SLE. Reductions of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were associated with reductions in medical costs. Twenty-three studies reported indirect costs. Across the US, costs due to absenteeism ranged from $1,606 to $6,195 and lost productivity ranged from $1,476 to $3,175. Seventy-three studies reported HCRU. SLE patients had between 0.3–3.5 emergency department visits per year and mean number of hospitalizations were between 0.1 to 2.4 per patient per year.

CONCLUSIONS: SLE patients experience significant economic burden globally including direct and indirect costs with direct costs being the major cost drivers. Patients with moderate to severe disease experience higher economic burden compared to those with mild disease. Findings of this review suggest the need for therapies that can reduce disease activity, improve outcomes, and reduce the economic burden.