Healthcare resource use and cost associated with varying dosages of extended corticosteroid exposure in a US population. (2nd September 2018)

• Record Type: Journal Article
• Authors: Rice, J. Bradford; White, Alan G.; Johnson, Michaela; Wagh, Aneesha; Qin, Yimin; Bartels-Peculis, Laura; Ciepielewska, Gosia; Nelson, Winnie W.
• Is Part Of: Journal of medical economics. Volume 21:Number 9(2018)
• Page Start: 846
• Page End: 852
• Publication Date: 2018-09-02
• Subjects: Extended corticosteroid exposure -- corticosteroids -- healthcare resource use -- costs -- dose-dependent response; I00 -- I19; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2018.1474750
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Aims: To quantify healthcare resource use (HCRU) and costs associated with varying levels of corticosteroid exposure. Materials and methods: Patients with a diagnosis of selected autoimmune and inflammatory diseases between 1 January 2006 and 30 September 2015 ("study period") were selected from a de-identified, privately-insured claims database. Patients were stratified into four treatment cohorts based on the dosing and duration of continuous corticosteroid use following disease diagnosis: intermittent use with <60 days of corticosteroid use and ≥60 days of corticosteroid use with low (≤7.5 mg/day), medium (>7.5–≤15 mg/day), or high (>15 mg/day) dosage. Patients were followed from the date of their highest dose episode of corticosteroid use ("treatment index date") until the earliest of the end of continuous corticosteroid use +30 days, disenrollment from health plan, or the end of the study period ("follow-up period"). HCRU and costs in the follow-up period were compared across treatment cohorts. Results: Of 78, 704 patients who were identified for study inclusion, 29% had extended corticosteroid use lasting ≥60 days, and 71% had intermittent use. On average, patients in the high-dose cohort incurred twice the cost of intermittent users ($68, 408 vs $32, 690 in annualized total all-cause healthcare costs, USD). Adverse event-related medical costs accounted for ∼40% of medical costs, and were higher than disease-related medical costs for all cohorts with extended corticosteroid exposure. Comparing the high-dose and low-dose cohorts, the smaller savings in disease-related prescriptions ($1, 680) occurred along with a much larger cost in adverse event-related spend ($13, 464). Limitations: The impact of corticosteroids may be under-estimated because of conservative follow-up duration, and administrative data may contain inaccuracies in coding. Conclusions : Steroid use, especially at higher doses, is associated with higher HCRU and costs.