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Patients with giant cell arteritis faced greater direct care cost due to greater health care use
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Patients with giant cell arteritis incurred a higher direct cost of care vs. patients without this condition starting at 1 month before diagnosis and continuing for 4 years after diagnosis, according to recently published findings.
In the retrospective population-based study, researchers evaluated 147 patients diagnosed with giant cell arteritis (GCA) in Olmsted County, Minnesota between Jan. 1, 1982 and Dec. 31, 2009. GCA was determined based on the 1990 American College of Rheumatology criteria.
Also evaluated was a cohort of 147 referent non-GCA individuals, who were individually matched with the GCA group for age, sex and calendar year. Researchers consulted the Mayo Clinic Cost Data Warehouse to collect data about use of outpatient health care resources, and cost data from this same database were used to determine estimates of nationally representative unit costs. All outpatient and inpatient health care costs incurred were included in the total direct costs. Follow-up for both groups was conducted until patient death, departure from Olmsted County, or Dec. 31, 2014.
Researchers found that during the year before GCA incidence/index date, the GCA group had a higher median difference (MD) in outpatient physician (MD=3) and laboratory (MD=2) visit days. Patients with GCA also had a higher MD in the number of radiology visit days (61% of patients with GCA had at least 2 visit-days vs. 43% of non-GCA group) and ophthalmologic visit days (54% of patients with GCA had at least 1 visit day vs. 35% of non-GCA group). Patients with GCA had more ophthalmologic procedures vs. the non-GCA group in years 0 to 1, 1 to 2, and 4 to 5. There was a similar frequency of emergency medicine visits, musculoskeletal and cardiovascular procedures between the groups for the duration of the study.
as seen in the GCA group during year 1, 2 and 4. A higher number of laboratory visit days was seen in the GCA group vs. the referent group in years 1, 2 and 3. Patients with GCA had significantly higher frequencies of radiologic visit days vs. the referent individuals in years 1 and 5.
The MD for total (inpatient and outpatient) direct health care costs for the entire year prior to incident/index data was not statistically significant (MD=$835). However, separate evaluation of each month revealed patients with GCA had significantly higher total health care cost (MD= $417) in the month before the incidence/index date. The greatest difference in cost seen between the two groups was documented during the first year (MD =$2,085). Statistically significant annual differences in outpatient costs persisted for patients with GCA during years 2 ($437), 3 ($382) and 4 ($388). Patients with GCA had significantly higher frequency of annual laboratory visit days vs. the non-GCA group for years 1 (MD= 9), 2 (MD=4) and 3 (MD=2).
“While we were not able quantify the difference in cost from this study due to active disease vs. disease/treatment sequelae and that given higher cost is seen not only in the first 1 year to 2 years but also in years 3 and 4 after diagnosis, the increased cost observed from the latter time frame is likely in part due to complications from chronic treatment (steroids)," study investigator Matthew J. Koster, MD, an instructor of medicine in the Department of Rheumatology at the Mayo Clinic, told Healio.com/Rheumatology. "Since tocilizumab has now just been approved for GCA, it will be important to evaluate prospectively the impact and cost-benefit of biologic agents on treatment outcomes and cost.” -by Jennifer Byrne
Disclosure: The researchers report no relevant disclosures.
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