Association between glucocorticoid exposure and healthcare expenditures for potential glucocorticoid-related adverse events in patients with rheumatoid arthritis
JH Best, AM Kong, GM Lenhart, K Sarsour… - The Journal of …, 2018 - jrheum.org
JH Best, AM Kong, GM Lenhart, K Sarsour, M Stott-Miller, Y Hwang
The Journal of rheumatology, 2018•jrheum.orgObjective. Oral glucocorticoid (OGC) use for rheumatoid arthritis (RA) is debated because of
the adverse event (AE) profile of OGC. We evaluated the associations between cumulative
doses of OGC and potential OGC-related AE, and quantified the associated healthcare
expenditures. Methods. Using the MarketScan databases, patients≥ 18 years old who have
RA with continuous enrollment from January 1 to December 31, 2012 (baseline), and from
January 1 to December 31, 2013 (evaluation period), were identified. Cumulative OGC dose …
the adverse event (AE) profile of OGC. We evaluated the associations between cumulative
doses of OGC and potential OGC-related AE, and quantified the associated healthcare
expenditures. Methods. Using the MarketScan databases, patients≥ 18 years old who have
RA with continuous enrollment from January 1 to December 31, 2012 (baseline), and from
January 1 to December 31, 2013 (evaluation period), were identified. Cumulative OGC dose …
Objective
Oral glucocorticoid (OGC) use for rheumatoid arthritis (RA) is debated because of the adverse event (AE) profile of OGC. We evaluated the associations between cumulative doses of OGC and potential OGC-related AE, and quantified the associated healthcare expenditures.
Methods
Using the MarketScan databases, patients≥ 18 years old who have RA with continuous enrollment from January 1 to December 31, 2012 (baseline), and from January 1 to December 31, 2013 (evaluation period), were identified. Cumulative OGC dose was measured using prescription claims during the baseline period. Potential OGC-related AE (osteoporosis, fracture, aseptic necrosis of the bone, type 2 diabetes, ulcer/gastrointestinal bleeding, cataract, hospitalization for opportunistic infection, myocardial infarction, or stroke) and AE-related expenditures (2013 US )weregatheredduringtheevaluationperiod.MultivariableregressionmodelswerefittedtoestimateORofAEandincrementalcostsforpatientswithAE.
Results
Therewere84,357patientsanalyzed,ofwhom48%usedOGCduringthebaselineperiodand26%hadanAEduringtheevaluationperiod.AcumulativeOGCdose>1800mgwasassociatedwithanincreasedriskofanyAEcomparedwithnoOGCexposure(OR1.19,99.65%CI1.09–1.30).IncrementalcostsperpatientwithanyAEweresignificantlygreaterforcumulativeOGCdose>1800mgcomparedwithnoOGCexposure(incrementalcost= 3528, 99.65% CI 2402– 4793).
Conclusion
Chronic exposure to low to medium doses of OGC was associated with significantly increased risk of potential OGC-related AE in patients with RA, and greater cumulative OGC dose was associated with substantially higher AE-related healthcare expenditures among patients with AE.
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