Incidence and US Costs of Corticosteroid-Associated Adverse Events: A Systematic Literature Review

Sarnes, Evelyn; Crofford, Leslie J.; Watson, Melanie; Dennis, Greg; Kan, Hong; Bass, Damon

doi:10.1016/j.clinthera.2011.09.009

Cited by 216 publications

(184 citation statements)

References 59 publications

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“…Many GC-related adverse events require substantial health care resource utilization and are potentially costly (14,15). Therefore, limiting exposure to GCs by concomitant GCsparing therapy could potentially improve the patient's quality of life and reduce the GC-associated economic burden.…”

Section: Introductionmentioning

confidence: 99%

Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs

Chen

Choi

et al. 2015

Arthritis Care & Research

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Objective. To investigate the determinants of health care utilization and costs with use of glucocorticoid (GC) drugs among adult systemic lupus erythematosus (SLE) patients. Methods. This cross-sectional study analyzed established SLE patients identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes from a large US insurance claims database in 2007-2011. Five patient groups were defined by their oral GC use during a 1-year period: non-GC users, <60 days of GC use, and ‡60 days of GC use in low dosage (£7.5 mg/day), medium dosage (>7.5 to £15 mg/day), or higher dosage (>15 mg/day). Annual health care utilization and costs were compared across these groups. Incremental costs of GC groups, calculated as the difference in total health care costs compared with those of the non-GC group, were estimated from multivariable regressions adjusting for demographic/clinical characteristics and stratified by concomitant immunosuppressant use. Results. A total of 50,230 SLE patients were identified (52% non-GC users, 20% <60 days of GC use, and 10% low dose, 10% medium dose, and 8% higher dose of ‡60 days of GC use). GC users had higher health care utilization and costs. Incremental costs were significant (all P < 0.01) for medium-dose ($5,319 and $6,913) and higher-dose ($12,517 and $15,019) GC groups, regardless of concomitant immunosuppressant use. The incremental costs for the low-dose GC group with concomitant immunosuppressants ($1,285; P 5 0.04) were smaller than the incremental costs for the low-dose GC group without concomitant immunosuppressants ($2,514; P < 0.01). Conclusion. GC use, especially at higher doses, was associated with higher health care utilization and costs. Findings in users with concomitant immunosuppressants suggest that therapies with a GC-sparing effect may be associated with lower economic burden in SLE treatment.

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Section: Introductionmentioning

confidence: 99%

Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs

Chen

Choi

et al. 2015

Arthritis Care & Research

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“…Many GC-related AEs are very costly; e.g. $18,357.90 for a bone fracture per year per episode [ 3 ]. Measurement of GC-related AEs, and their impact on patients, is important for establishing both the overall clinical effectiveness and the cost-effectiveness of any treatment strategies intended to reduce total GC exposure.…”

Section: Introductionmentioning

confidence: 99%

The Prediction and Monitoring of Toxicity Associated with Long-Term Systemic Glucocorticoid Therapy

et al. 2015

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Glucocorticoids are often required for adequate control of inflammation in many serious inflammatory diseases; common indications for long-term treatment include polymyalgia rheumatica, giant cell arteritis, asthma and chronic obstructive pulmonary disease. Long-term glucocorticoid therapy is, however, associated with many adverse effects involving skin, gastrointestinal, eye, skeletal muscle, bone, adrenal, cardio-metabolic and neuropsychiatric systems. This balance between benefits and risks of glucocorticoids is important for clinical practice and glucocorticoid-related adverse effects can significantly impair health-related quality of life. Understanding the nature and mechanisms of glucocorticoid-related adverse effects may inform how patients are monitored for toxicity and identify those groups, such as older people, that may need closer monitoring. For clinical trials in diseases commonly treated with glucocorticoids, standardised measurement of glucocorticoid-related adverse effects would facilitate future evidence synthesis and meta-analysis.

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“…They were divided in three 6 presented no mental or physical illnesses. This information was obtained through a brief semi-structured interview conducted when the women contacted us to participate in the study.…”

Section: Patientsmentioning

confidence: 99%

The effects of corticosteroids on cognitive flexibility and decision-making in women with lupus

Montero-López

Santos-Ruiz

Navarrete‐Navarrete

et al. 2016

Lupus

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Abstract:The aim of this study was to investigate the possible effects of corticosteroids in women with systemic lupus erythematosus (SLE) in two processes of executive function: cognitive flexibility and decision-making. To that end, we evaluated 121 women divided into three groups: 50 healthy women, 38 women with SLE not receiving corticosteroid treatment and 33 women with SLE receiving corticosteroid treatment. Cognitive flexibility was measured with the Trail Making Tests A and B; decisionmaking was measured with the Iowa Gambling Task. Additionally, demographic (age and education level), clinical (SLEDAI, SDI and disease duration) and psychological characteristics (stress vulnerability, perceived stress and psychopathic symptomatology) were evaluated. The results showed that both SLE groups displayed poorer decision-making than the healthy women (p = 0.006) and also that the SLE group receiving corticosteroid treatment showed lower cognitive flexibility than the other two groups (p = 0.030). Moreover, they showed the poorest scores on the following SCL-90-R subscales: somatisation (p = 0.005), obsessions and compulsions (p = 0.045), depression (p = 0.004), hostility (p = 0.013), phobic anxiety (p = 0.005), psychoticism (p = 0.016) and positive symptom total (p = 0.001). Additionally, they were more vulnerable to stress (p = 0.000). These findings help to understand the effects of corticosteroid treatment on cognitive flexibility and decision-making, in Corticosteroids, executive function and lupus E Montero-López et al. 1 AbstractThe aim of this study was to investigate the possible effects of corticosteroids in women with systemic lupus erythematosus (SLE) in two processes of executive function:cognitive flexibility and decision-making. To that end, we evaluated 121 women divided into three groups: 50 healthy women, 38 women with SLE not receiving corticosteroid treatment and 33 women with SLE receiving corticosteroid treatment. vulnerable to stress (p = 0.000). These findings help to understand the effects of corticosteroid treatment on cognitive flexibility and decision-making, in addition to the disease-specific effects suffered by women with SLE.

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Incidence and US Costs of Corticosteroid-Associated Adverse Events: A Systematic Literature Review

Abstract: Based on the findings from this review, systemic corticosteroids are a common cause of AEs that may be costly to payers.

Cited by 216 publications

References 59 publications

Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs

Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs

The Prediction and Monitoring of Toxicity Associated with Long-Term Systemic Glucocorticoid Therapy

The effects of corticosteroids on cognitive flexibility and decision-making in women with lupus

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