Healthcare resource use and cost associated with varying dosages of extended corticosteroid exposure in a US population

Rice, J. Bradford; White, Alan G.; Johnson, Michaela E.; Wagh, Aneesha; Qin, Yimin; Bartels-Peculis, Laura; Ciepielewska, Gosia; Nelson, Winnie W.

doi:10.1080/13696998.2018.1474750

Cited by 12 publications

(15 citation statements)

References 14 publications

(16 reference statements)

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“…Cost and health care resource utilization generally rose with dosage category. 21 These findings come from a claims database study of adults with various autoimmune or inflammatory conditions. 21 Database studies in the United States that are specific to SLE also have linked corticosteroid use and higher corticosteroid dose with higher health care utilization and costs.…”

Section: Discussionmentioning

confidence: 99%

<p>Treatment Patterns and Health Care Costs of Lupus Nephritis in a United States Payer Population</p>

Bartels-Peculis¹,

Sharma²,

Edwards³

et al. 2020

OARRR

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Objective: To describe the characteristics, treatment patterns, health care resource utilization (HCRU), and cost of care for members of a large United States (US) health insurance plan with lupus nephritis (LN). Methods: A retrospective observational study was conducted using a health insurance plan database to identify adult members with a diagnosis of LN. Medical and pharmacy claims were used to describe demographics, comorbidities, HCRU, and cost patterns over a 12month follow-up period for each patient, between January 1, 2014, and December 31, 2016. All study variables were examined descriptively. Results: A total of 1039 patients were available for analysis (median age, 47 years; 83% female). The median Charlson Comorbidity Index (CCI) was 3.3. Less than half (41%) of patients received immunosuppressive therapies commonly used to treat LN. Evidence indicated that 58% of the study population were prescribed corticosteroid therapy, in most cases (73%) for more than 60 days. Adverse events known to be associated with corticosteroid therapy were recorded in 58% of patients. Guideline-recommended preventive therapy with hydroxychloroquine was prescribed for 54% of members with LN. Nearly half (47%) of members with LN did not see a nephrologist and more than one-third (36%) did not see a rheumatologist over 1 year of follow-up. Rates of all-cause hospitalization and emergency department (ED) use were 25% and 35%, respectively. The mean all-cause per-member-permonth (PMPM) medical cost for the study population was $2801, with LN-specific costs accounting for $1147 PMPM. Conclusion: Patients with LN who are insured through a large US health plan appeared to underutilize outpatient specialist services and guideline-recommended hydroxychloroquine therapy. Corticosteroid use and adverse events known to be associated with corticosteroids were common in this cohort.

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Section: Discussionmentioning

confidence: 99%

<p>Treatment Patterns and Health Care Costs of Lupus Nephritis in a United States Payer Population</p>

Bartels-Peculis¹,

Sharma²,

Edwards³

et al. 2020

OARRR

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“…Because this was an exploratory and hypothesis-generating study, we did not make any comparisons between RCI and a control group or other treatments, which may also result in bias. It is important to note the following: RCI is indicated for symptomatic sarcoidosis; 15 RCI is included in treatment guidelines from the Foundation for Sarcoidosis Research; 11 and a phase IV, double-blind randomized placebo-controlled clinical trial is ongoing to examine the safety and efficacy of Acthar Gel in patients with pulmonary sarcoidosis (ClinicalTrials. gov Identifier: NCT03320070).…”

Section: Limitationsmentioning

confidence: 99%

“…2,3 However, evidence links long-term and high-dose corticosteroid use with increased risk of adverse events (AEs) and higher health care utilization costs in various patient populations. [10][11][12] Other treatment options for sarcoidosis include off-label use of antimetabolites, immunosuppressants, tumor necrosis factor inhibitors, and antimalarial agents. 2,13 Limited evidence supports the use of these agents in patients with sarcoidosis.…”

Section: Introductionmentioning

confidence: 99%

Repository corticotropin injection in patients with advanced symptomatic sarcoidosis: retrospective analysis of medical records

Chopra¹,

Qin

Kranyak

et al. 2019

Ther Adv Respir Dis

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Background:Repository corticotropin injection (RCI) has regulatory approval for many indications, including symptomatic sarcoidosis. This large case series of patients with advanced symptomatic sarcoidosis treated with RCI describes patient characteristics, RCI utilization patterns, concomitant therapies, and physicians’ assessments of treatment response.Methods:Patients ⩾18 years with symptomatic sarcoidosis, treated with RCI in the previous 36 months, who had completed a course of RCI or received RCI for ⩾6 months at the time of data collection were included.Results:The study included 302 patients (mean age, 51 years; 52%, women) with a mean 4.8 years since initial diagnosis of sarcoidosis. Most patients (76%) had extrapulmonary involvement, primarily in the skin (28%), joints (25%), heart (22%), and eyes (22%); 34% had multiple (⩾2) organ involvement. The mean duration of RCI treatment was 32.5 weeks, with 61.6% of patients continuing RCI therapy for ⩾6 months. The RCI utilization pattern indicated an individualized approach to therapy, with a higher starting dose associated with a shorter duration of therapy compared with a lower starting dose. The percentage of patients who used corticosteroids decreased from 61.3% during the 3 months before initiation of RCI to 12.9% 3 months after RCI therapy; the mean daily dose of corticosteroid decreased from 18.2 mg to 9.9 mg. The proportion of patients given <10 mg/day of prednisone increased from 21% before RCI use to 47% 3 months after RCI use. According to physicians’ assessments of change in patients’ health status after RCI therapy, overall status improved in 95% of patients, overall symptoms in 73%, lung function in 38%, and inflammation in 33%.Conclusions:The findings suggest that RCI is a viable treatment option for patients with advanced symptomatic sarcoidosis and provide insights on patient characteristics and practice patterns to help clinicians determine appropriate use. The reviews of this paper are available via the supplemental material section.

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“…The need factors were the number of preindex csDMARD claims, the number of preindex ts/bDMARD claims, preindex pain indicators (number of NSAID/opioid claims), preindex glucocorticoid claims, glucocorticoid treatment type (doses as defined below) within 60 days of the preindex date, and select individual comorbidities at index. Aligning with the work by Chen et al [25] and Rice et al [26,27], we used the following definitions to describe glucocorticoid treatment: intermittent (\ 60 days) or extended (C 60 days) at low (B 7.5 mg/day), medium ([ 7.5 -B 15 mg/day), or high ([ 15 mg/day) doses. For patients with extended-use glucocorticoids, the average daily dose (ADD) was also calculated.…”

Section: Variables and Outcome Measuresmentioning

confidence: 99%

Patient Characteristics and Indicators of Treatment Initiation with Repository Corticotropin Injection in Patients with Rheumatoid Arthritis: A Claims Database Analysis

Hayes

Panaccio

Goel³

et al. 2021

Rheumatol Ther

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Repository corticotropin injection (RCI) is indicated as adjunctive, short-term therapy in selected patients with RA. To characterize RCI users and identify predictors of RCI initiation in RA, we compared preindex characteristics, treatment patterns, comorbidities, healthcare resource utilization (HCRU), and costs for patients who had initiated RCI treatment (RCI cohort) versus patients with no RCI claims and ≥ 1 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD) claim (non-RCI ts/bDMARD cohort). We analyzed pharmacy and medical claims data from a large commercial and Medicare supplemental administrative database. Inclusion criteria were age ≥ 18 years, ≥ 1 inpatient or ≥ 2 outpatient claims with RA diagnosis (January 1, 2007–December 31, 2018), and 12-month continuous medical and pharmacy coverage preindex. Results from baseline cohort comparisons informed multiple logistic regression analysis. Compared with the non-RCI ts/bDMARD cohort ( n = 162,065), the RCI cohort ( n = 350) had a greater proportion of patients with higher Charlson comorbidity index (CCI) scores; higher mean claims-based index of RA severity and CCI scores; greater frequency of almost all comorbidities; higher use of nontraditional DMARDs, glucocorticoids, and opioids; higher all-cause HCRU; and higher medical and total costs. By multivariable analysis, the most significant predictors of RCI initiation were intermittent glucocorticoid use at any dose (odds ratio [OR] 1.67), extended-use glucocorticoids at medium (OR 2.03) and high doses (OR 2.99), nontraditional DMARD use (OR 2.09), anemia (OR 1.39), and renal disease (OR 2.45). Before RCI initiation, patients had more severe RA, higher comorbidity burden, greater use of glucocorticoids and opioids, and higher HCRU compared with non-RCI initiators. The most significant predictors for starting RCI in patients with RA were intermittent use of glucocorticoids at any dose, extended-use high-dose glucocorticoids, use of nontraditional DMARDs, and comorbid anemia and renal disease. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00272-x.

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Healthcare resource use and cost associated with varying dosages of extended corticosteroid exposure in a US population

Abstract: Steroid use, especially at higher doses, is associated with higher HCRU and costs.

Cited by 12 publications

References 14 publications

<p>Treatment Patterns and Health Care Costs of Lupus Nephritis in a United States Payer Population</p>

<p>Treatment Patterns and Health Care Costs of Lupus Nephritis in a United States Payer Population</p>

Repository corticotropin injection in patients with advanced symptomatic sarcoidosis: retrospective analysis of medical records

Patient Characteristics and Indicators of Treatment Initiation with Repository Corticotropin Injection in Patients with Rheumatoid Arthritis: A Claims Database Analysis

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