Background/Purpose: To quantify the healthcare expenditures associated with oral glucocorticoids-related-adverse events (OGCs-AEs), among patients in the US with giant cell arteritis (GCA) using claims data from MarketScan^® Commercial and Medicare Supplemental Databases.

Methods: Patients age ≥50 years with GCA and at least one OGC prescription fill, during 1/1/2009-6/30/2014 (first OGC claim after GCA diagnosis date = index date) were selected. Cumulative dose of OGCs was measured during the 1-year post-index period. Patients were stratified in four cohorts (>0 to ≤2,607 mg, >2,607 to ≤4,800 mg, >4,800 to ≤7,200 mg, >7,200 mg) based on the distribution of OGC exposure. Incidence of potential AEs and AE-related direct healthcare costs (2016 USD) were also assessed during the 1-year post-index period. A generalized linear model with log link and gamma distribution was used to evaluate the association between the log of cumulative dose of OGCs and AE-related direct healthcare costs, adjusting for baseline characteristics.

Results: The 1,602 GCA patients (mean age 73, 69% females) had mean cumulative OGC dose post-index of 5,806 mg (median=4,800 mg), with most exposure occurring in the first 6 months. The proportion of patients with any potential OGCs-AEs was 36.5% overall (n=584) and increased as cumulative dose increased (30.7%-45.3% across quartiles). Unadjusted mean AE costs for patients with an AE was $12,818 (median=$1,844). In the multivariable model, increasing OGC dose was associated with increasing AE-related healthcare costs (cost ratio=1.38 [95% CI 1.16-1.64) per 1 unit increase in log(cumulative OGC dose), p<0.001). Mean (median) predicted AE costs for the dosing quartiles were: $4,389 ($2,749) for >0 to ≤2,607 mg, $5,176 ($3,009) for >2,607 to ≤4,800 mg, $5,576 ($3,633) for >4,800 to ≤7,200 mg, $6,609 ($4,447) for >7,200 mg.

Conclusion: Rates of OGCs-AEs tended to increase with an increase in cumulative OGC dose, which resulted in increased healthcare costs. These results highlight the need for efficacious therapies that reduce the exposure and potential risks associated with OGCs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/healthcare-cost-of-potential-glucocorticoid-associated-adverse-events-in-patients-with-giant-cell-arteritis/