{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:21:32Z","timestamp":1792045292811,"version":"4.4.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Belimumab is a biologic therapy for active, autoantibody-positive systemic lupus erythematosus (SLE) that has been shown to reduce disease activity, flare frequency, and glucocorticoid use, thereby preventing organ damage. Belimumab is typically reserved for refractory disease, but emerging evidence suggests earlier initiation may lead to higher response rates, greater achievement of remission or low disease activity, and further reduction in glucocorticoid use.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the economic and health-related outcomes of early vs delayed belimumab initiation for biologic-naive patients with clinically active SLE, comparing medical costs and quality-adjusted life-years (QALYs).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This economic evaluation using cost-utility analysis from a US payer perspective was conducted with a Markov model with monthly cycles over a 15-year horizon and was informed by studies published from 2013 to 2025, identified through a targeted literature review. Biologic-naive adult SLE patients with active disease (SLE Disease Activity Index 2000 score &amp;gt;0) were included. Patients began in a pretreatment state and transitioned monthly between 5 health states: complete response (per SLE Responder Index-4 [SRI-4]), partial response, nonresponse (failure to meet SRI-4 accompanied by flare or treatment-emergent adverse event), no treatment (standard of care), and death.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Early (\u22642 years of disease duration) or delayed (after failure of standard therapy) initiation of intravenous belimumab.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes included total direct medical costs, QALYs, incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB). The 95% uncertainty intervals (UIs) for incremental costs, QALYs, and INMB were calculated from the 2.5 and 97.5 percentiles of the probabilistic sensitivity analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The modeled cohort included 1000 adults (912 female [91.2%]) with a mean (SD) age of 41 (11) years at belimumab initiation. Early initiation provided an additional 0.30 (95% UI, \u22120.42 to 1.39) QALYs at an incremental cost of \u2013$126\u202f337.12 (95% UI, \u2013$910\u202f010.39 to $168\u202f383.94) per patient relative to delayed initiation, yielding a favorable ICER of \u2013$421\u202f123.73 per QALY. At a $50\u202f000 per QALY threshold, the mean INMB was $141\u202f337.12 (95% UI, \u2013$157\u202f997.53 to $925\u202f019.51), with early initiation preferred in 81.3% of simulations (8125 of 10\u202f000 simulations). Deterministic sensitivity analyses identified time horizon (INMB range, $6351.07 for a 1-year horizon to $156\u202f497.12 for a lifetime horizon) and SRI-4 response odds ratio (INMB range, $69\u202f741.68 for an odds ratio of 1.08 to $209\u202f591.09 for an odds ratio of 3.47) as the most influential parameters.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this economic evaluation of early vs delayed belimumab in biologic-naive patients with active SLE, early initiation was associated with improved health outcomes and reduced costs. These findings support earlier clinical adoption and reconsideration of reimbursement criteria to reflect long-term value.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.60167","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T16:00:44Z","timestamp":1771516844000},"page":"e2560167","source":"Crossref","is-referenced-by-count":4,"title":["Cost-Effectiveness of Early vs Delayed Belimumab Treatment for Systemic Lupus Erythematosus"],"prefix":"10.1001","volume":"9","author":[{"given":"Sabrina","family":"Hundal","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"Division of Experimental Medicine, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Cappelli","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Sj\u00f6wall","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahi","family":"Touma","sequence":"additional","affiliation":[{"name":"Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Parodis","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, and Center for Molecular Medicine, Stockholm, Sweden"},{"name":"Department of Rheumatology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie R.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mary Washington Healthcare, Fredericksburg, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Netchiporouk","sequence":"additional","affiliation":[{"name":"Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"issue":"3","key":"zoi251606r1","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1136\/ard-2022-223035","article-title":"Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study.","volume":"82","author":"Tian","year":"2023","journal-title":"Ann Rheum Dis"},{"issue":"11","key":"zoi251606r2","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1136\/ard-2023-225319","article-title":"Management of systemic lupus erythematosus: a systematic literature review informing the 2023 update of the EULAR recommendations.","volume":"83","author":"Kostopoulou","year":"2024","journal-title":"Ann Rheum Dis"},{"issue":"9","key":"zoi251606r3","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1136\/annrheumdis-2013-205171","article-title":"Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the systemic lupus international collaborating clinics (SLICC) inception cohort.","volume":"74","author":"Bruce","year":"2015","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"zoi251606r4","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.autrev.2012.12.001","article-title":"The use of glucocorticoids in systemic lupus erythematosus. 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