(246) Quantifying the productivity burden of lupus nephritis and the potential value of obinutuzumab treatment

Background: : Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE), which disproportionately affects women of childbearing age during their prime working years. The REGENCY trial (NCT04221477) evaluated obinutuzumab (OBI), a humanized type II anti-CD20 monoclonal antibody, plus standard therapy (ST) for treatment of LN. While productivity loss in SLE has been studied, data on the specific impact and benefits of advanced therapies, like OBI, on productivity loss in LN are limited. To address this, we used an algorithm (Jiao & Basu, 2023) to indirectly estimate productivity impacts on LN based on age and health-related quality-of-life, considering both market (labor) and non-market activities (including caregiving and volunteering).

Objective: : To estimate the lifetime productivity burden of LN and gains from OBI treatment.

Methods: : Using a Markov cost-effectiveness model, we simulated progression of patients with LN treated with ST (mycophenolate mofetil plus glucocorticoids) or OBI plus ST across chronic kidney disease stages 1-3b, 4 and 5. Transition probabilities were obtained from the REGENCY trial and literature. Health state utilities were derived from prior health technology assessment submissions. Age-specific general US population utilities were from Jiang et al. 2023. Patient time was valued by applying average US hourly wage (market and non-market) and fringe benefits (market only), sourced from the US Bureau of Labor Statistics 2025. Patient-level estimates were extrapolated to the US population using the LN incidence rate (1.3 per 100 000 person-years) from Hocaoglu et al. 2023.

Results: : Patients with LN on ST incurred an average lifetime productivity loss of $345 327 per person compared with the general population, with 79% ($271 119) attributed to market productivity loss. Addition of OBI to ST resulted in a lifetime productivity gain of $36 958 per person due to improved disease prognosis. At the population level, treating patients with OBI plus ST over 10 years could avert an estimated $1.63B in lifetime productivity losses versus ST alone. This includes savings of $1.33B in market productivity and $305M in non-market productivity, translating to an estimated $972M in averted lost wages and $140M in increased national tax revenue.

Conclusions: : Treatment with OBI could significantly mitigate the lifetime productivity burden of LN by reducing lost wages and increasing tax revenue. These findings, alongside clinical efficacy shown in the REGENCY trial, support the value of OBI in LN treatment regimens.

Sponsorship:: Genentech, Inc.