Dataset Information

Management of Gout in the United States: A Claims-based Analysis.

ABSTRACT: OBJECTIVE:Gout is the most common inflammatory arthritis in the United States. Although numerous guidelines exist for the management of gout, they are not routinely implemented. This study evaluated the real-world practice patterns in gout patients using large administrative claims databases. METHODS:An analysis of patients diagnosed with gout from October 2015 to November 2018 was carried out using the Symphony Integrated Dataverse and Truven Marketscan administrative claims databases. Patients were identified as having gout if they were more than18 years of age and had 2 or more primary gout diagnoses on different days, separated by 3 or more months. Patients were further identified as having either acute gout or advanced forms of gout including chronic nontophaceous, tophaceous, and uncontrolled gout. Percent and frequency of serum urate testing, rheumatology specialist visits, prescriptions for urate lowering therapies (ULTs), and emergency room (ER) visits for gout flares were evaluated. RESULTS:We identified 1?162 747 gout patients. Gout patients were seen most frequently by internists and family medicine practitioners. Neither urate testing nor prescriptions for ULTs were uniform. Patients with acute gout were infrequently seen by rheumatologists, whereas rheumatologist care progressively increased in patients with advanced gout. The frequency of serum urate testing and prescriptions for ULTs significantly increased, whereas the frequency of ER visits decreased in gout patients seen by a rheumatologist. CONCLUSION:Measurement of serum urate and prescriptions for ULTs are not consistent in gout patients. Rheumatologist care increases the frequency of urate measurement and ULT prescriptions and may also improve outcomes for gout patients.

SUBMITTER: Edwards NL

PROVIDER: S-EPMC7077776 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Management of Gout in the United States: A Claims-based Analysis.

Edwards N Lawrence NL Schlesinger Naomi N Clark Sanders S Arndt Theresa T Lipsky Peter E PE

ACR open rheumatology 20200301 3

<h4>Objective</h4>Gout is the most common inflammatory arthritis in the United States. Although numerous guidelines exist for the management of gout, they are not routinely implemented. This study evaluated the real-world practice patterns in gout patients using large administrative claims databases.<h4>Methods</h4>An analysis of patients diagnosed with gout from October 2015 to November 2018 was carried out using the Symphony Integrated Dataverse and Truven Marketscan administrative claims data ...[more]

PMID: 32114719

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Project description:PurposeTo identify if non-infectious uveitis (NIU) is associated with a greater risk of coronavirus disease 2019 (COVID-19) infection, hospitalization, and death.DesignA retrospective cohort study from January 20, 2020 to December 31, 2020 using a national claims-based database.ParticipantsEnrollees who had continuous enrollment with both medical and pharmacy coverage for three years prior to January 20, 2020. Patients with an NIU diagnosis within three years of the start of the study were included in the NIU cohort. Those with infectious uveitis codes or new NIU diagnoses during the risk period were excluded.MethodsCox proportional hazards models were used to identify unadjusted hazard ratios as well as adjusted hazard ratios for all covariates for each outcome measure. Adjusted models accounted for patient demographics, health status, and immunosuppressive medication use during the risk period.Main outcome measuresRates of COVID-19 infection, COVID-19-related hospitalization, and COVID-19-related in-hospital death identified with International Classification of Disease 10th revision codes.ResultsThis study included 5,806,227 patients of which 29,869 (0.5%) had a diagnosis of NIU. On unadjusted analysis, patients with NIU had a higher rate of COVID-19 infection (5.7% vs. 4.2%, p<0.001), COVID-19-related hospitalization (1.2% vs. 0.6%, p<0.001) and COVID-19-related death (0.3% vs. 0.1%, p<0.001). However, in adjusted models, NIU was not associated with a greater risk of COVID-19 infection (hazard ratio [HR] = 1.05; 95% confidence interval [CI]: 1.00 - 1.10; p = 0.04), hospitalization (HR = 0.98; 95% CI: 0.88 - 1.09; p = 0.67) or death (HR = 0.90, 95% CI: 0.72 - 1.13, p = 0.37). Use of systemic corticosteroids was significantly associated with higher risk of COVID-19 infection, hospitalization, and death.ConclusionsPatients with NIU were significantly more likely to be infected with COVID-19 and experience severe disease outcomes. However, this association was due to the demographics, comorbidities, and medications of patients with NIU, rather than to NIU alone. Patients utilizing systemic corticosteroids were significantly more likely to be infected with COVID-19 and were at greater risk of hospitalization and in-hospital death. Additional investigation is necessary to identify the impact of corticosteroid exposure on COVID-19-related outcomes.

Project description:BackgroundOcular inflammation causes significant visual morbidity in the United States, yet little is known about the epidemiology of infectious uveitis and scleritis. This study aims to evaluate the epidemiology of infectious uveitis/scleritis employing a large national medical claims database.MethodsThis was a retrospective, case-control study, employing Optum's de-identified Clinformatics® Data Mart Database, containing data from 21.5 million privately insured individuals with enrollment for at least 15 months within 2007-2015. Inclusion in the uveitis/scleritis sample required an index uveitis/scleritis diagnosis based on International Classification of Diseases, Ninth Revision (ICD-9) codes. Exclusion criteria included index date within 3 months after intraocular surgery. Rates for uveitis/scleritis were determined by anatomic site. Multivariable logistic regression analyses were performed to determine odds ratios for the incidence and prevalence of uveitis/scleritis by anatomic category.FindingsInfectious etiologies accounted for less than 20% of uveitis/scleritis, with mean rates of 18.9 (incidence) and 60.6 (prevalence) per 100,000 persons. The mean prevalences of infectious anterior, intermediate, posterior, panuveitis, and scleritis were 27.7, 0.17, 23.4, 4.4, and 4.6, per 100,000, respectively. Overall risk of prevalent infectious uveitis/scleritis increased with age (OR>3.3 for each decade over age 18, p<0.01), female sex (OR = 1.2, p<0.01), non-Hispanic white race (OR<1 for all other races, p<0.01), as well as the East South Central census division (OR = 1.2, p<0.01), comprising Alabama, Kentucky, Missouri, and Tennessee. Medical comorbidities, including HIV infection (OR = 6.4, p<0.01) and rheumatologic disease (OR = 1.9, p<0.01), were common in the infectious uveitis/scleritis cohort.ConclusionsThe incidence and prevalence of infectious uveitis/scleritis in the United States were higher than previously reported estimates but remained lower than in developing countries. Rates varied by age, sex, race, and medical comorbidities, and may reflect differential susceptibility to various infectious agents with disparate geographic distributions within the United States.

Project description:INTRODUCTION:Conventional pharmaceutical interventions for inflammatory bowel disease (IBD) provide limited disease/symptom control and are associated with an increased risk of adverse events (AEs). These limitations increase patient morbidity, medical resource utilization (MRU), and costs. METHODS:The IQVIA™ Real-World Data Adjudicated Claims-US database was leveraged to identify adult patients (>?18 years) with Crohn's disease (Crohn's) or ulcerative colitis (UC), who were new and chronic users (??60 days) of oral corticosteroids (OCS), immunosuppressants (IS), anti-tumor necrosis factor agents (anti-TNF) or combinations thereof. Using aminosalicylate-treated patients as a reference, we compared AE incidence, MRU, and medical costs across drug classes. RESULTS:The analysis included 30,676 patients (Crohn's: n?=?14,528; UC: n? = 16,148). OCS monotherapy was the strongest predictor of any AE occurring [Crohn's: hazard ratio 1.62 (1.51-1.73); UC: hazard ratio 1.57 (1.49-1.66)]. A similar pattern was observed for severe infection and bone-related conditions. Patients with UC or Crohn's receiving OCS or IS plus OCS were more likely to have emergency department visits, IBD-related hospitalizations/visits/procedures, and gastrointestinal surgery than were patients receiving other therapies. Annualized total medical costs (pharmacy plus hospital service costs) were greatest for anti-TNF plus IS or anti-TNF therapy in both Crohn's and UC. Annualized medical service costs (excluding IBD drug costs) were highest for patients initiating OCS-containing therapies [Crohn's: OCS, $27,041 (24,882-29,200) and OCS plus IS, $23,332 (19,889-26,775); UC: OCS, $19,659 (17,977-21,340)]. CONCLUSION:Although biologic therapies have higher pharmacy costs, treatment decisions should consider the increased AE risks and long-term MRU costs associated with chronic use of OCS-containing therapies. FUNDING:This study was funded by F. Hoffmann-La Roche Ltd. The journal's Rapid Service Fee and Open Access publication were paid for by ApotheCom on behalf of Genentech, a member of the Roche group who funded the study.

Project description:IntroductionSpinal muscular atrophy (SMA) is a rare, genetic neuromuscular disorder caused by deletion/mutation of the survival motor neuron 1 gene, characterized by progressive loss of motor neurons, resulting in increasing muscular weakness, deteriorating motor function, and, in its most severe form, death before 2 years. Nusinersen, an antisense oligonucleotide that increases expression of the functional SMN protein, was approved for SMA by US and European regulatory agencies in 2016 and 2017, respectively. The indicated regimen requires intrathecal injections every 4 months, following the first four injections during the loading phase. Adherence is integral to treatment success. Adherence to nusinersen may pose particular challenges as most patients with SMA are young children who require complex multidisciplinary care (including ongoing intrathecal treatment administration and potential specialized anesthetic and surgical procedures) at specialized centers. However, real-world data on adherence to nusinersen are limited.MethodsWe conducted a retrospective claims database analysis from December 23, 2016, to November 20, 2019, to study nusinersen adherence and discontinuation/persistence in US patients with SMA types 1-3 who completed the loading phase, and to determine the impact of non-adherence or treatment discontinuation on SMA-related comorbidities, health care resource utilization (HCRU), and costs.ResultsWe identified 23 patients with SMA type 1, 41 patients with SMA type 2, and 260 patients with SMA type 3 who had completed the loading phase. Deviations from the indicated nusinersen treatment schedule were frequent in real-world usage, with most patients receiving ≥1 dose outside the scheduled interval. Across SMA types, non-adherent patients were more likely to have had SMA-related comorbidities (e.g., feeding difficulties, dyspnea and respiratory anomalies, and muscle weakness) and greater HCRU. Persistence rates 12 months after treatment initiation for patients with SMA types 1, 2, and 3 were 55.2%, 42.4%, and 54.6%, respectively. Patients who discontinued nusinersen and those who did not had generally similar comorbidity profiles. Discontinuation was associated with greater health care costs across SMA types.ConclusionOur analysis of claims data indicated that discontinuation and non-adherence to nusinersen treatment were prevalent, and associated with greater frequency of comorbidities, greater HCRU, and increased costs for patients.

Project description:Despite several studies that have estimated the economic impact of Respiratory Syncytial Virus (RSV) in infants, limited data are available on healthcare resource use and costs attributable to RSV across age groups. The aim of this study was to quantify age-specific RSV-related healthcare resource use and costs on the US healthcare system.This retrospective case-control study identified patients aged ?1 year with an RSV event in the Truven Health Marketscan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases between August 31, 2012 and August 1, 2013. RSV patients were matched 1:1 with non-RSV controls for age, gender, region, healthcare plan and index date (n?=?11,432 in each group). Stratified analyses for healthcare resource use and costs were conducted by age groups. RSV-attributable resource use and costs were assessed based on the incremental differences between RSV cases and controls using multivariate analysis.RSV patients had a higher healthcare resource use (hospital stays, emergency room/urgent care visits, ambulatory visits and outpatient visits) than non-RSV matched controls for all age groups (all p?<?0.0001), particularly in the elderly age groups with RSV (1.9 to 3 days length of stay, 0.4 to 0.5 more ER/UC visits, 0.7 to 2.7 more ambulatory visits, 12.1 to 18.6 more outpatient visits and 9.5 to 14.6 more prescriptions than elderly in the control groups). The incremental difference in adjusted mean annual costs between RSV and non-RSV controls was higher in elderly (?65; $12,030 to $23,194) than in those aged <?65 years ($2251 to $5391). Among children, adjusted costs attributable to RSV were higher in children aged 5-17 years ($3192), than those 1-4 years ($2251 to $2521).Our findings showed a substantial annual RSV-attributable healthcare resource use and costs in the US across age groups, with the highest burden in those aged ?65 years. These data can be used in cost-effectiveness analyses, and may be useful for policymakers to guide future RSV vaccination and other prevention programs.

Dataset Information

Management of Gout in the United States: A Claims-based Analysis.

Publications

Management of Gout in the United States: A Claims-based Analysis.

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