Background/Purpose:
Gout is a chronic progressive disease and worldwide prevalence is increasing. After over 40 years with limited and inexpensive treatments several new and more expensive treatment options are available. Although gout treatment guidelines are well established, variances in treatment patterns exist. The objective was to identify the rate of gout by state and estimate the budget impact of treating patients with chronic urate lowering and acute gout treatments.
Methods:
Estimates from NHANES were used to project the rate of gout by state and compared to Symphony Health Solutions’ ProMetis longitudinal patient data. Symphony Health Solutions’ PHAST database provides destailed estimates of chronic and acute pharmaceutical treatments for gout.Looking at prevelance rates across states and treatment estimates between 2007 and 2012 costs by state by yearare estimated and presented in constant dollars using published wholesale acquisition costs for drugs.
Results:
In 2011 gout is estimated to impact 9.2 million individuals based on NHANES estimates. Total gout pharmaceutical spend in the 2012 data was $1.038 billion, a 918% increase since 2007. Total number of prescriptions for gout rose 27% over the same time period. The costs of gout treatments vary: allopurinol at less than a dollar a day, febuxostat $2,250 per year; and pegloticase has the potential to cost as much as $100,000 per year. Acute and prophylaxic treatment colchicine now costs between $4.94 and $9.88 per day. Four states were identified accounting for approximately 30% of all pharmaceutical spending on gout; California, Florida, Texas and New York. Although colchicine does not treat the underlying urate burden found in patients with gout it accounted for over 55% of the total drug spend for patients with gout in in 2012; up from less than 20% in 2007. Among urate lowering therapies, febuxostat accounted for 60% of pharmaceutical costs, yet, allopurinol accounted for 93% of all fills across the U.S. State-by-state differences were seen in the utilization of urate lowering therapies, with higher colchicine prescribing leading to increased drug expenditure within certain states. Hawaii (1377%), South Carolina (1324%) and Georgia (1274%) have been most affected by increasing gout treatment costs, driven primarily by colchicine prescribing.
Conclusion:
With an aging population and increasing rates of obesity, the rate of gout will continue to rise in the US. Recently launched drugs have increased the drug spend on gout. Forthcoming and likely expensive treatments will further add to the pharmaceutical budget impact of gout in the coming years. Reviewing treatment patterns within geographies will identify opportunities for gout education; including early identification, lifestyle management, treating the underlying cause of the disease vs. symptoms and utilization of effective generic medications. Early identification and treatment with effective generic medications will offer savings to the health care system. 
Disclosure:
A. Davis,
None;
J. Wreath,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-the-increasing-costs-to-manage-patients-with-gout-by-state/