Higher Daily Hospitalization Costs and Intensive Care Utilization Among Decedents With Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Bioethical Analysis of End‐of‐Life Care

Introduction End‐of‐life care creates financial burdens. This study examines medical procedures/interventions and costs for inpatients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), comparing those who died during hospitalization to those who survived, analyzing the findings through a bioethical perspective. Methods This observational 1:1 case‐control study was conducted at a tertiary care center. Patients with SLE and RA (ICD‐10‐CM diagnostic codes) who were hospitalized for at least 24 h during two distinct periods—January–June 2019 and January–June 2023—were included. Patients were designated as cases if they died during hospitalization and as controls if they were discharged alive. Data were abstracted from electronic medical records using standardized formats. Microcosting data for each hospitalization were obtained from the accounting department. Results We identified 29 matched pairs of cases and controls, primarily comprising middle‐aged females, with SLE. Cases and controls had similar sociodemographic and disease‐related characteristics. However, cases spent a greater proportion of their hospitalization time in the intensive care unit (100% [33.9–100] vs. 27.5% [13.4–45], p ≤ 0.001) and had higher incidence of complications (75.9% vs. 34.5%, p = 0.003). Daily hospitalization costs were significantly higher for cases (USD 3348 vs. 2707.4, p = < 0.001). More cases utilized blood bank services, while fewer engaged in clinical nutrition‐related procedures. Conclusions Decedents with SLE/RA had higher daily hospitalization costs than matched survivors, in the context of greater ICU utilization, complications, and blood bank use. End‐of‐life scenarios are complex; clinical decisions should be examined through bioethical lens.