ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2507

Healthcare Resource Utilization in Patients with Secondary Sjögren’s Syndrome Associated with RA Compared with Patients with RA in an Insured Population

Evo Alemao1, Aarti Rao2, Chidananda Samal2 and Robert Wong1, 1Bristol-Myers Squibb, Princeton, NJ, 2Mu Sigma, Bangalore, India

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Secondary Sjögren’s syndrome (sSS) is a rheumatic disease that may coexist with RA. Joint disease is more severe in patients (pts) with RA with versus without sSS.1 There are limited data on healthcare resource use (HCRU) of pts with RA with sSS.

Methods: Pts (≥18 years) from the Optum™ Clinformatics™ Data Mart administrative claims database with incident RA (≥2 claims for RA with International Classification of Diseases [ICD]-9 [714.0] or ICD-10 [M05.xxx/M06.0xx/M06.8xx/M06.9] and ≥1 claim for a conventional DMARD) from Jan 2010 to Jun 2016 were included. Two mutually exclusive RA cohorts were created: one with incident sSS (≥2 claims for SS with ICD-9 [710.2] or ICD-10 [M35.0x]) and one without sSS. The index date was the first diagnosis date of sSS (RA with sSS) or RA (RA without sSS). All-cause HCRU was captured during a 12-month period from (and including) the index date (post-index period). Statistical differences in HCRU between cohorts were assessed using chi-square and Kruskal-Wallis tests. For RA with sSS, HCRU during the 12 months pre- and post-index period was compared using McNemar and Wilcoxon sign rank tests.

Results: Overall, 1858 pts with RA with sSS and 21,264 with RA without sSS met inclusion criteria and were analyzed. Of pts with RA with sSS, first sSS diagnosis occurred before RA in 630 (33.9%), after RA in 978 (52.6%) and on the same date in 250 (13.5%). Pts with RA with (vs without) sSS were younger, more likely to be female and had higher incidences (standardized difference >10%) of fibromyalgia, gastrointestinal reflux, hypothyroidism, osteoporosis, systemic sclerosis/scleroderma and systemic lupus erythematosus (Table 1). After sSS diagnosis, proportionally more pts with RA with sSS had inpatient admissions (vs the pre-index period, Table 2). Mean length of stay and number of inpatient visits, outpatient visits and prescriptions were higher in the post-index period (Table 2). Pts with RA with sSS had more outpatient visits and prescriptions than pts with RA without sSS (Table 3).

Conclusion: Pts with RA with sSS (vs pts with RA without sSS) had more comorbidities at baseline. Also, pts with RA with sSS had an increased HCRU post-sSS diagnosis. Further research is needed to understand if HCRU use is associated with clinical manifestation of sSS.

Reference:

  1. Brown LE, et al. Rheumatology (Oxford) 2015;54:816–20.

Table 1. Baseline Characteristics and Comorbidities by Cohort

Pts with RA with sSS

(n=1858)

Pts with RA without sSS (n=21,264)

p value

Standardized difference

Age, years, mean (SD)

58.7 (13.9)

61.3 (14.5)

<0.0001

–

Female sex, n (%)

1665 (89.6)

15,503 (72.9)

<0.0001

–

CCI, mean (SD)

1.6 (1.6)

1.0 (1.4)

<0.0001

–

Comorbidities, n (%)

Avascular necrosis

8 (0.4)

72 (0.3)

0.517

–0.015

Bronchiolitis

12 (0.6)

51 (0.2)

0.001

–0.061

Celiac disease

14 (0.8)

72 (0.3)

0.005

–0.056

Chronic/recurrent cystitis

18 (1.0)

148 (0.7)

0.182

–0.030

COPD/asthma

51 (2.7)

633 (3.0)

0.571

0.014

Dyslipidemia

623 (33.5)

7733 (36.4)

0.015

0.060

Fibromyalgia

491 (26.4)

3669 (17.3)

<0.0001

–0.223

Gastrointestinal reflux

478 (25.7)

3922 (18.4)

<0.0001

–0.176

Hypertension

932 (50.2)

11,595 (54.5)

0.0003

0.088

Hypothyroidism

520 (28.0)

4402 (20.7)

<0.0001

–0.170

Ischemic heart disease

199 (10.7)

2783 (13.1)

0.003

0.074

Myocardial infarction

28 (1.5)

434 (2.0)

0.115

0.041

Peripheral vascular disease

223 (12.0)

2353 (11.1)

0.219

–0.029

Peptic ulcer disease

15 (0.8)

147 (0.7)

0.565

–0.014

Primary biliary cirrhosis

10 (0.5)

24 (0.1)

<0.0001

–0.075

Osteoporosis

280 (15.1)

2250 (10.6)

<0.0001

–0.135

Osteoarthritis

739 (39.8)

8738 (41.1)

0.268

0.027

Pulmonary nodule

108 (5.8)

793 (3.7)

<0.0001

–0.098

Renal disease

178 (9.6)

2018 (9.5)

0.899

–0.003

Systemic sclerosis/scleroderma

54 (2.9)

157 (0.7)

<0.0001

–0.163

SLE

343 (18.5)

1259 (5.9)

<0.0001

–0.391

Transient ischemic attack

32 (1.7)

366 (1.7)

0.997

–0.0001

Vasculitis, retinal

2 (0.1)

11 (0.1)

0.281

–0.020

Vasculitis, other

33 (1.8)

278 (1.3)

0.093

–0.038

CCI=Charlson Comorbidity Index; COPD=chronic obstructive pulmonary disease; pt=patient; sSS=secondary Sjögren’s syndrome; SLE=systemic lupus erythematosus

Table 2. Healthcare Resource Utilization During the 12-Month Pre-Index Period and 12-Month Post-Index Period for the sSS Cohort

RA with sSS in pre-index period

(n=1858)

RA with sSS in post-index period

(n=1858)

p value

Number of patients utilizing healthcare services, n (%)

Inpatient admissions

371 (20.0)

439 (23.6)

0.003

Outpatient services

1645 (88.5)

1652 (88.9)

0.442

Emergency visits

408 (22.0)

401 (21.6)

0.716

Urgent care visits

49 (2.6)

51 (2.7)

0.819

Pharmacy prescriptions

1821 (98.0)

1849 (99.5)

<0.0001

Number of healthcare services utilized, mean (SD)

Inpatient admissions

2.2 (3.4)

2.4 (4.0)

0.001

Length of stay, days

8.8 (14.1)

11.3 (20.0)

0.001

Outpatient visits

30.6 (28.5)

36.6 (30.6)

<0.0001

Emergency visits

5.0 (5.7)

5.9 (7.8)

0.249

Urgent care visits

1.7 (1.3)

1.6 (0.9)

0.724

Pharmacy prescriptions

44.1 (35.3)

53.5 (37)

<0.0001

sSS=secondary Sjögren’s syndrome

Table 3. Healthcare Resource Utilization During the 12-Month Post-Index Period

Pts with RA with sSS

(n=1858)

Pts with RA without sSS (n=21,264)

p value

Number of patients utilizing healthcare services, n (%)

Inpatient admissions

439 (23.6)

5143 (24.2)

0.589

Outpatient services

1652 (88.9)

19,008 (89.4)

0.522

Emergency visits

401 (21.6)

4683 (22.0)

0.660

Urgent care visits

51 (2.7)

543 (2.6)

0.617

Pharmacy prescriptions

1849 (99.5)

21,098 (99.2)

0.158

Number of healthcare services utilized, mean (SD)

Inpatient admissions

2.4 (4.0)

2.6 (4.6)

0.459

Length of stay, days

11.3 (20.0)

13.0 (23.0)

0.389

Outpatient visits

36.6 (30.6)

33.1 (30.8)

<0.0001

Emergency visits

5.9 (7.8)

5.5 (6.7)

0.655

Urgent care visits

1.6 (0.9)

1.8 (1.7)

0.613

Pharmacy prescriptions

53.5 (37)

49.6 (35.3)

<0.0001

sSS=secondary Sjögren’s syndrome

Disclosure: E. Alemao, Bristol-Myers Squibb, 1, 3; A. Rao, Mu Sigma for Bristol-Myers Squibb, 5; C. Samal, Mu-sigma, 5; R. Wong, Bristol-Myers Squibb, 1, 3.

To cite this abstract in AMA style:

Alemao E, Rao A, Samal C, Wong R. Healthcare Resource Utilization in Patients with Secondary Sjögren’s Syndrome Associated with RA Compared with Patients with RA in an Insured Population [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/healthcare-resource-utilization-in-patients-with-secondary-sjogrens-syndrome-associated-with-ra-compared-with-patients-with-ra-in-an-insured-population/. Accessed .

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