Increased cost of idiopathic inflammatory myopathies begins 2 years before diagnosis
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The mean annual direct and indirect costs related to idiopathic inflammatory myopathies are three to five times higher than in the general population, and begin increasing 2 years before diagnosis, according to data from a Swedish registry.
“In Sweden, [idiopathic inflammatory myopathies (IIM)] prevalence is estimated at 14 per 100,000 with a 10-year cumulative mortality of 31%,” Valérie Leclair, MD, FRCPC, of the Karolinska Institute and Karolinska University Hospital, in Stockholm, Sweden, and colleagues wrote in Seminars in Arthritis and Rheumatism. “Cancer and cardiorespiratory diseases are the leading causes of death. With substantial mortality and morbidity, the economic burden of IIM in terms of direct costs related to diagnostic investigations, ambulatory care and hospitalizations are significant.”
“Previous estimates of direct IIM costs included heterogeneous study populations and overlooked the impact of a simultaneous cancer diagnosis,” they added. “In other systemic autoimmune rheumatic diseases, indirect costs (ie, productivity loss) often exceed direct costs. While a few studies have reported on indirect costs in IIM, none included the pre-diagnostic period. Estimates of the global economic burden of IIM is important for health care funders and researchers to plan resource allocation, research priorities and interventions.”
To estimate the annual direct and indirect costs related to idiopathic inflammatory myopathies over time, including the period prior to diagnosis, Leclair and colleagues analyzed a cohort of adult patients from the Swedish National Patient Register. Focusing on the period from 2010 to 2016, the researchers identified 673 patients who were diagnosed with either juvenile dermatomyositis, dermatomyositis, polymyositis or inclusion body myositis during that time.
Each patient was then matched, based on birth year, sex and area of residence at index year, to five comparators from the general population — a total of 3,343 control individuals — identified from the Swedish Population Register. The researchers calculated costs using national register data. Direct disease-related costs including hospitalization and outpatient specialist visits, with sick leave, disability pension and productivity loss making up to indirect costs.
According to the researchers, costs related to idiopathic inflammatory myopathies started increasing as early as 2 years prior to diagnosis. By the year following diagnosis, the mean annual cost was 21,639 (about $25,526) compared with 4,816 (about $5,681) in the general population. At 5 years after diagnosis, the mean annual cost in the myopathy group was 12,796 (about $15,095).
Outpatient visits, hospitalizations and productivity loss were the main drivers of the overall increase in annual expenditures among the myopathy cohort. In addition, indirect costs accounted for a significant portion of long-term societal costs related to idiopathic inflammatory myopathies. The highest costs were found among patients of working age with cancer-associated disease.
“In the 5-year period following diagnosis, mean annual IIM costs were three to five times higher than in the general population, representing an important societal cost,” Leclair and colleagues wrote. “These expenses started to increase before diagnosis, were at their peak in the year following diagnosis and remained elevated thereafter.”
“Facilitating access to specialized multidisciplinary care has the potential to reduce delay in diagnosis and improve long-term outcomes in IIM,” they added. “Indirect costs contributed to a large extent to the long-term economic burden of IIM. Early in the disease course, clinicians and allied health professionals should aim to improve function, prevent damage and address barriers to return-to-work to reduce these costs.”
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