Trends in Gout and Rheumatoid Arthritis Hospitalizations in Canada From 2000 to 2011

Abstract

Objective Gout and rheumatoid arthritis (RA) are the two most common forms of inflammatory arthritis worldwide. As hospitalizations for both conditions lead to substantial health resource use, contemporary inpatient trends and associated costs may provide important benchmarks of disease burden. However, relevant data are limited. Methods We used PopulationData BC, a population-based administrative dataset from Canada. We examined trends in the annual hospitalization and surgery rate of gout and RA from 2000-2011. We additionally examined annual trends in the inpatient cost burden of both conditions. We assessed annual trends in hospitalization and surgery rates using Poisson regression models and cost trends using linear regression models. Results From 2000 to 2011, the annual hospitalization rate for RA declined by 49% from 15.4 to 7.9 per 100,000 Canadian adults (p<0.001), whereas that for gout doubled from 3.8 to 7.6 per 100,000 Canadian adults (p<0.001). Approximately 31% of RA admissions were associated with hip or knee replacement surgery; the trend of these surgeries paralleled the declining trend in RA hospitalizations (p=0.0097). The inpatient costs also reflected the hospitalization trends, with a 40% decrease in RA hospital costs, while gout costs more than doubled over the study period. Conclusion Our findings indicate that hospitalization rates for gout have doubled over the past decade, while those for RA have decreased considerably. While these data provide an encouraging benchmark for RA care, they also highlight the critical need to improve gout management and prevention to mitigate its rising disease burden in Canada and beyond.

Temporal trends and regional disparity in rheumatoid arthritis and gout hospitalizations in Sweden, 1998–2015

“…The declining trend in RA hospitalizations in our study is consistent with decreasing trends in orthopedic surgeries and hospitalizations for RA reported from different locations [ 8 – 11 , 19 ]. These reductions are mainly attributed to better management of RA including treating to target, early and more aggressive use of disease-modifying antirheumatic drugs, and introduction of biologic agents [ 6 , 9 ]. Although reductions in RA hospitalizations and hospital days imply decrease in RA hospitalization costs, this decrease likely indicates a shift in RA costs rather than reduction in RA total costs (i.e., reduction in hospitalization costs offset by rise in medication costs) [ 6 , 11 , 19 ].…”

“…These improvements led to reductions in orthopedic surgeries and hospitalizations for RA in several countries [ 8 – 11 ]. By contrast, studies reported persistent suboptimal management of gout [ 12 , 13 ] with no improvement in premature mortality gap and rise in health care visits over recent decade [ 9 , 10 , 14 – 16 ]. Despite the rising burden of gout, to our knowledge, there is limited data on temporal trend in gout hospitalizations and its contrast with RA hospitalizations over recent decades.…”

Discordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)

“…By contrast, rheumatologists generally see gout as a chronic, very often progressive, condition that has acute flares but a tendency to progress. With gout increasing in prevalence, and with so many patients being older and affected by multiple comorbidities, gout is becoming more challenging to manage, as indicated (in part) by a marked increase in severe acute gout flares requiring hospitalization 52,53 . The G-CAN position is that the ACP's stance on ULT, essentially that ULT can be prescribed without urate monitoring or optimization of ULT dose to achieve urate concentrations below the saturation threshold of soluble urate 1 , is particularly troubling as it could help perpetuate the common practice pattern of underdosing of ULT 54 .…”

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“…Socioeconomic difficulties faced by hospitals are related to direct costs which involve examinations, laboratory tests, hospital admission, conventional synthetic and biologic disease modifying drugs, caregiver assistance, transportation and equipment. The improvement in RA symptoms through rheumatologist and nurse-led care (12), the use of conventional DMARDs instead of the more expensive biological therapy (13), the use of subcutaneous-injected biologic agents instead of the more expensive infused biologic therapy, a larger clinical setting with high patient volume involving a more efficient use of equipment (1), avoiding switching to another anti-TNF or to a biologic with a different mechanism of action (14), earlier treatment initiation, improved treatment strategies with conventional DMARDs, including triple therapy (3), negotiated cost discounts and utilization limits (15,16) can be used for cost optimization.…”