Adrenal Insufficiency: Burden of Disease and Cost of Illness

Chauhan, Richa; Lee, D.

doi:10.1016/j.jval.2013.08.651

Cited by 3 publications

(3 citation statements)

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“…The UK cost of illness study suggested that inpatient admissions are a major cost driver of AI [ 5 ]. In a recent analysis, using the same cohorts as the current study, we found hospital inpatient admissions to be significantly higher in AI patients vs controls: for one admission in the matched control group, there were 4.64 admissions in the PAI cohort P < 0.0001.…”

Section: Discussionmentioning

confidence: 99%

“…The literature on cost of treatment of AI is very limited. A recent study involving about 20,000 patients in the United Kingdom estimated the cost per patient of £1922 (USD $3,411) giving a total annual cost for the AI patient population of the UK of £39.7 million (USD $70.5 million) [ 5 ]. There are several cost drivers of AI that include but are not limited to diagnosis, less efficacious treatment strategies, comorbidities associated with the underlying disease, and possible side effects induced by the glucocorticoid replacement.…”

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confidence: 99%

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Health Care Burden in Patients With Adrenal Insufficiency

Gunnarsson

Ryan

Marelli³

et al. 2017

Journal of the Endocrine Society

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Objective:This study aimed to estimate the annual health care burden for patients with adrenal insufficiency [AI; primary (PAI), secondary to pituitary disorder (PIT), and congenital adrenal hyperplasia (CAH)] using real-world data.Methods:Using a US-based payer database comprising >108 million members, strict inclusion criteria with diagnostic codes and pharmacy records were used to identify 10,383 patients with AI. This included 1014 patients with PAI, 8818 with PIT, and 551 with CAH, followed for >12 months. Patients were matched 1:1 to controls, based on age (±5 years), sex, insurance, and region. Multivariable expenditure models were estimated for each AI cohort vs controls as well as subsets by glucocorticoid therapy (hydrocortisone, dexamethasone, prednisone, or multiple therapies). A separate multivariable model was estimated to assess the association between adherence and expenditures.Results:Total annual health care expenditure estimates were significantly higher (P < 0.0001) in all AI cohorts compared with matched controls (PAI $18,624 vs $4320, PIT $32,218 vs $6956, CAH $7677 vs $4203). Patients with AI have more frequent inpatient hospital stays with up to eight to 10 times more days in the hospital per year than their matched controls. In each AI cohort, patients on multiple steroid therapies had higher expenditures in comparison with patients using hydrocortisone therapy alone. In PAI and PIT cohorts taking hydrocortisone only, fewer expenditures were found in higher adherence subsets.Conclusion:Patients with AI demonstrate a substantial annual health care burden. Expenditures vary by underlying cause and treatment and are reduced in patients with higher adherence to glucocorticoid replacement.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Health Care Burden in Patients With Adrenal Insufficiency

Gunnarsson

Ryan

Marelli³

et al. 2017

Journal of the Endocrine Society

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“…AI poses a significant health burden on patients, their families, and the healthcare system. A UK study in 2013 estimated an annual cost of illness associated with AI at £39.7 million for approximately 20,000 patients ( 16 ). Health care cost for patients with AI is four times higher than for the general population ( 17 ).…”

Section: Introduction: Self-management For Patients With Adrenal Insu...mentioning

confidence: 99%

Using the behaviour change wheel and person-based approach to develop a digital self-management intervention for patients with adrenal insufficiency: the Support AI study protocol

Llahana,

Mulligan,

Hirani

et al. 2023

Front. Endocrinol.

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IntroductionMost patients with Adrenal insufficiency (AI) require lifelong glucocorticoid replacement. They need to increase glucocorticoids during physical illness or major stressful situations and require parenteral hydrocortisone in the event of an adrenal crisis. Patients with AI have impaired quality of life and high mortality; approximately 1 in 6-12 patients are hospitalised at least once/year from a potentially preventable adrenal crisis. Adoption of self-management behaviours are crucial; these include adherence to medication, following “sick day rules” and associated behaviours that aid prevention and treatment of adrenal crisis such as symptom monitoring, having extra tablets, carrying a medical-alert ID and injection kit, and self-injecting when necessary. Current patient education is ineffective at supporting self-management behaviour change or reducing adrenal crisis-related hospitalisations. This research study aims to gain an in-depth understanding of the barriers and enablers to self-management for patients with AI and to develop an evidence-based digital self-management behaviour change intervention.MethodsThe study is conducted in accordance with the MRC Framework for developing complex interventions. Underpinned by the Behaviour Change Wheel (BCW), the Theoretical Domains Framework (TDF), and the Person-Based Approach, this research will be conducted in two phases: Phase 1 will involve a sequential qualitative/quantitative mixed-methods study involving focus group interviews followed by a cross-sectional survey with patients with AI recruited from patient advocacy groups and endocrine clinics in the UK. Phase 2 will develop the Support AI, a website-based digital behaviour change intervention (DBCI) informed by Phase 1 findings to support self-management for patients with AI. The most appropriate behaviour change techniques (BCTs) will be selected utilising a nominal group technique with an Expert Panel of 10-15 key stakeholders. The design of the Support AI website will be guided by the Person-Based Approach using an Agile iterative “think-aloud” technique with 12-15 participants over 3 usability testing iterations.ConclusionA theory- and evidence-based digital behaviour change intervention will be developed which will be tested in a feasibility randomised trial following completion of this study. The projected benefit includes cost-effective health care service (reduced hospitalisations and demand for specialist services) and improved health outcomes and quality of life for patients with AI.

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