Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with systemic sclerosis (SSc) are at high risk of developing interstitial lung disease (ILD) and/or pulmonary hypertension (PH). These two lung manifestations are associated with significant morbidity and are the leading causes of death in SSc. In this study, in addition to describing survival experience, we sought to assess the financial burden by determining all-cause healthcare costs in patients with SSc with and without coexistent ILD and/or PH.
Methods: We used data from the MarketScan Commercial and Medicare Supplemental Databases from 2004-2014. Patients with ≥2 claims with a diagnosis of SSc (ICD-9-CM 710.1) were identified. Patients with 6 months of continuous enrollment prior to first SSc diagnosis in the database and with no claims for SSc during that period were classified as incident patients. Patients with ≥2 claims with a diagnosis of ILD (ICD-9-CM 515, 516.3, 516.31, 517.2) and no diagnoses of other respiratory conditions were classified as having ILD. Patients with ≥2 claims with a diagnosis of PH (ICD-9-CM 416.0) were classified as having PH. Those without claims for these conditions in the 6 months prior to first diagnosis of ILD or PH in the database were considered incident. All-cause mortality was assessed for incident patients who could be linked to Social Security Administration death data. All-cause healthcare costs were calculated over a 5-year follow-up period for incident patients with sufficient enrollment.
Results: There were 11,752 incident SSc patients, 1,808 SSc patients with incident ILD, and 1,223 SSc patients with incident PH. Average age at first diagnosis of SSc, ILD, and PH was 55 years, 57 years, and 60 years, respectively. Among those who could be linked to death records (n=4,605; n=715; n=525), median survival time was 11.3 years, 8.8 years, and 6.0 years. Per-patient all-cause healthcare costs over a 5-year follow-up were lowest for newly diagnosed SSc patients and highest for SSc patients with newly diagnosed PH ($101,839; $191,107; $254,425). Yearly per-patient costs are presented by service type in Tables 1-3.
Conclusion: In comparison to those with SSc alone, the presence of ILD and/or PH is associated with significant increases in healthcare costs and a worse survival experience. Table 1.
|
All-Cause Healthcare Costs of Incident SSc Patients (N=1,957) |
|||||
| Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | |
| Inpatient admissions |
$4,691 |
$3,780 |
$3,770 |
$4,492 |
$6,101 |
| Emergency room visits |
$337 |
$290 |
$290 |
$311 |
$261 |
| Outpatient office visits |
$1,392 |
$1,164 |
$1,153 |
$1,168 |
$1,173 |
| Other outpatient services |
$9,060 |
$7,779 |
$7,327 |
$7,869 |
$8,677 |
| Outpatient pharmacy |
$5,418 |
$5,822 |
$5,973 |
$6,486 |
$7,055 |
| Total healthcare costs |
$20,898 |
$18,836 |
$18,513 |
$20,325 |
$23,268 |
Table 2.
|
All-Cause Healthcare Costs of SSc Patients with Incident ILD (N=219) |
|||||
| Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | |
| Inpatient admissions |
$7,693 |
$7,643 |
$3,502 |
$7,735 |
$22,609 |
| Emergency room visits |
$450 |
$474 |
$461 |
$425 |
$344 |
| Outpatient office visits |
$1,794 |
$1,410 |
$1,458 |
$1,455 |
$1,567 |
| Other outpatient services |
$14,051 |
$13,375 |
$12,387 |
$9,485 |
$14,578 |
| Outpatient pharmacy |
$11,260 |
$13,013 |
$13,476 |
$14,112 |
$16,348 |
|
|
|
|
|
|
|
| Total healthcare costs |
$35,248 |
$35,916 |
$31,285 |
$33,212 |
$55,446 |
Table 3.
|
All-Cause Healthcare Costs of SSc Patients with Incident PH (N=108) |
|||||
| Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | |
| Inpatient admissions |
$9,203 |
$5,383 |
$5,641 |
$8,317 |
$12,413 |
| Emergency room visits |
$789 |
$703 |
$785 |
$347 |
$365 |
| Outpatient office visits |
$1,912 |
$1,640 |
$1,508 |
$1,594 |
$1,579 |
| Other outpatient services |
$17,355 |
$12,984 |
$9,850 |
$13,565 |
$18,002 |
| Outpatient pharmacy |
$20,769 |
$24,294 |
$26,671 |
$27,796 |
$30,962 |
|
|
|
|
|
|
|
| Total healthcare costs |
$50,028 |
$45,003 |
$44,454 |
$51,620 |
$63,320 |
To cite this abstract in AMA style:
Raimundo K, Farr A, Cole A, Fischer A. Assessment of Mortality and Healthcare Costs Associated with Systemic Sclerosis with and without Lung Involvement [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/assessment-of-mortality-and-healthcare-costs-associated-with-systemic-sclerosis-with-and-without-lung-involvement/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-mortality-and-healthcare-costs-associated-with-systemic-sclerosis-with-and-without-lung-involvement/