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First 3 years of GCA linked with greater cumulative incremental cost
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During the first 3 years of giant cell arteritis, patients incurred a significantly greater cumulative incremental cost increase vs. age-matched controls, according to findings.
In the population-based, retrospective cohort study, researchers reviewed the French National Health Insurance System Database to identify 96 patients with incident giant cell arteritis (GCA) and 563 matched controls. They performed a cost analysis from the French health insurance perspective, accounting for direct medical and non-medical costs. Evaluation of care consumption was conducted by assessing different cost components and dividing this into periods of 6 months. Researchers used longitudinal multivariate regression analyses with generalized estimating equations to adjust the impact of GCA on mean cost with time.
Researchers found that during the first 3 years of follow-up, GCA was associated with a cumulative incremental cost of 6,406 euros, and this number was 7,236 euros in the 5-year follow-up. The first 18 months encompassed significantly higher incremental total costs vs. other time intervals, and equaled 1,342 euros for the first 6 months; 1,498 euros between 6 months and 12 months, and 1,165 euros between 12 months and 18 months. Between 18 months and 24 months, incremental total costs were reduced to 890 euros; between 24 months and 30 months, this number was reduced to 713 euros; and between 30 months and 36 months, the incremental total costs were 799 euros. These costs were primarily prompted by paramedical procedures, inpatient stays, medication and medical procedures.
The incremental cost of paramedical procedures at 3 years was 2,113 euros, and increased to 2,084 euros in 5 years. There were significant disparities between GCA and control group costs for the first 3 years, mostly due to nursing and physiotherapy.
The most significant driver of incremental cost was medication. The following classes of drugs influenced the mean cost difference between GCA and control groups: analgesic and NSAIDs, corticosteroids, anti-osteoporosis drugs, protein pump inhibitors, anti-infective agents, antidepressants and central nervous system drugs.
In patients with GCA, a significant cost increase was observed during the first 3 years of follow-up (RR: 1.27). A significant reduction in mean cost was seen in patients with GCA during the fourth and fifth years of follow-up (RR: 0.70), which tended to equal that of control patients.
The incremental cost of medical procedures was 751 euros at 3 years and 1,306 euros in 5 years. These differences were significant for the first 30 months of follow-up
“Overall, our study shows that the incremental total costs of GCA compared to matched controls is significantly higher for the first 3 years with drug prescriptions, paramedical and medical procedures mainly driving those costs,” the researchers wrote. They added, “With regard to the future use of expensive biotherapies in the management of GCA, an efficiency evaluation must be carried out to assist in the decision-making process when limiting resources to ensure the sustainability of the health care system.” – by Jennifer Byrne
Disclosures: The authors report no relevant disclosures.
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