Association Between Glucocorticoid Exposure and Healthcare Expenditures for Potential Glucocorticoid-related Adverse Events in Patients with Rheumatoid Arthritis
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$) were gathered during the evaluation period. Multivariable regression models were fitted to estimate OR of AE and incremental costs for patients with AE.
RESULTS: There were 84,357 patients analyzed, of whom 48% used OGC during the baseline period and 26% had an AE during the evaluation period. A cumulative OGC dose > 1800 mg was associated with an increased risk of any AE compared with no OGC exposure (OR 1.19, 99.65% CI 1.09-1.30). Incremental costs per patient with any AE were significantly greater for cumulative OGC dose > 1800 mg compared with no OGC exposure (incremental cost = $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.
Errataetall: |
CommentIn: J Rheumatol. 2018 Mar;45(3):293-296. - PMID 29496913 |
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Medienart: |
E-Artikel |
Erscheinungsjahr: |
2018 |
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Erschienen: |
2018 |
Enthalten in: |
Zur Gesamtaufnahme - volume:45 |
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Enthalten in: |
The Journal of rheumatology - 45(2018), 3 vom: 07. März, Seite 320-328 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Best, Jennie H [VerfasserIn] |
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Links: |
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Themen: |
ADVERSE EFFECTS |
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Anmerkungen: |
Date Completed 22.10.2019 Date Revised 22.10.2019 published: Print-Electronic CommentIn: J Rheumatol. 2018 Mar;45(3):293-296. - PMID 29496913 Citation Status MEDLINE |
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doi: |
10.3899/jrheum.170418 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM279975805 |
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500 | |a Date Revised 22.10.2019 | ||
500 | |a published: Print-Electronic | ||
500 | |a CommentIn: J Rheumatol. 2018 Mar;45(3):293-296. - PMID 29496913 | ||
500 | |a Citation Status MEDLINE | ||
520 | |a 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 | ||
520 | |a 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$) were gathered during the evaluation period. Multivariable regression models were fitted to estimate OR of AE and incremental costs for patients with AE | ||
520 | |a RESULTS: There were 84,357 patients analyzed, of whom 48% used OGC during the baseline period and 26% had an AE during the evaluation period. A cumulative OGC dose > 1800 mg was associated with an increased risk of any AE compared with no OGC exposure (OR 1.19, 99.65% CI 1.09-1.30). Incremental costs per patient with any AE were significantly greater for cumulative OGC dose > 1800 mg compared with no OGC exposure (incremental cost = $3528, 99.65% CI $2402-$4793) | ||
520 | |a 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 | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Observational Study | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
650 | 4 | |a ADVERSE EFFECTS | |
650 | 4 | |a CORTICOSTEROIDS | |
650 | 4 | |a GLUCOCORTICOIDS | |
650 | 4 | |a HEALTHCARE COSTS | |
650 | 4 | |a RHEUMATOID ARTHRITIS | |
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700 | 1 | |a Lenhart, Gregory M |e verfasserin |4 aut | |
700 | 1 | |a Sarsour, Khaled |e verfasserin |4 aut | |
700 | 1 | |a Stott-Miller, Marni |e verfasserin |4 aut | |
700 | 1 | |a Hwang, Yong |e verfasserin |4 aut | |
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