Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Eosinophilic granulomatosis with polyangiitis (EGPA), is a rare, complex multisystem disorder, characterized by vascular inflammation and multisystem organ damage. EGPA manifests as asthma, rhinosinusitis, blood/tissue eosinophilia, and vasculitis. In part due to its rare nature, there is an absence of burden of illness data. This study aims to quantify healthcare resource utilization and costs associated with EGPA from the managed care perspective in the United States (US).
Methods: A retrospective analysis was conducted using a large, US administrative claims database (study period: 01 July 2007 to 31 March 2017). Patients were 18 years of age or older with continuous health plan enrollment (6-months pre-index and 12-months post-index). The index date was the date of EGPA diagnosis. Prior to the implementation of ICD-10 (October 2015), EGPA diagnosis was based on published algorithms.1,2 Post October 2015, EGPA diagnosis was based on ICD-10 code M30.1 (polyarteritis with lung involvement [Churg-Strauss]). An unmatched asthma control group was identified to evaluate the incremental impact of EGPA. Clinical and economic characteristics are reported as counts, percentages and means, with statistical comparisons evaluated at α=0.05 level.
Results: The study included 2,226 EGPA and 48,252 asthma patients (Table 1). The EGPA cohort was older, predominantly female and had greater comorbidity (top three: hypertension, other lower respiratory conditions and other connective tissue conditions) as compared with the asthma cohort. In the pre-index period, the proportion of patients utilizing services and the mean number of services utilized were significantly greater in the EGPA cohort compared with the asthma cohort (all p<0.001, except ambulatory). Pre-index costs were significantly greater in the EGPA cohort compared with the asthma cohort (mean: $14,325 vs. $5,050; p<0.001). In the 12-month post-index period, significant differences between the EGPA and asthma cohorts were observed for the proportion of patients utilizing services (ambulatory: 73.0% vs. 77.0%, p<0.001; emergency department [ED]: 42.1% vs. 31.7%, p<0.001; inpatient [IP]: 29.0% vs. 16.2%, p<0.001; prescriptions (Rx): 70.3% vs. 75.9%; p<0.001), the mean number of services utilized (ambulatory: 31.7 vs. 18.5, p<0.001; ED: 1.4 vs. 1.0, p<0.001; IP: 0.6 vs. 0.2, p<0.001, IP length of stay [days]: 5.4 vs. 1.9, p<0.001; Rx: 45.1 vs. 32.9, p<0.001) and mean costs (total: $31,914 vs. $13,822; p<0.001; medical: $26,441 vs. $10,694; p<0.001; pharmacy: $5,473 vs. $3,128, p<0.001).
Conclusion: This study provides valuable real-world data about the substantial burden of EGPA, which was significantly greater in terms of resource utilization and costs when compared with an asthma cohort.
Funded by GlaxoSmithKline (Study #: HO-17-17742)
1Sreih et al. Pharmacoepidemiol Drug Saf. 2016;25:1368-74
2Harrold et al. Pharmacoepidemiol Drug Saf. 2004;13:661-7
|
Table 1. Study Results |
|
|
|
|
Variables |
EGPA Cohort |
Asthma Cohort |
p-value |
|
N |
2,226 |
48,252 |
|
|
Index date prior to 01 October 2015, N (%) |
2,173 (97.6%) |
46,368 (96.1%) |
<0.001 |
|
Age, mean (SD) |
59.7 (14.2) |
56.5 (15.8) |
<0.001 |
|
Female, N (%) |
1,558 (70.0%) |
31,757 (65.8) |
<0.001 |
|
Quan-Charlson Comorbidity Index, mean (SD) |
1.8 (1.7) |
0.7 (1.2) |
<0.001 |
|
Pre-index comorbidities, N (%) |
|
|
|
|
Hypertension
|
1,322 (59.7%) |
19,862 (44.7%) |
<0.001 |
|
Other lower respiratory diseases
|
1,260 (56.9%) |
15,409 (34.7%) |
<0.001 |
|
Other connective tissue dsieases
|
1,213 (54.8%) |
13,180 (29.7%) |
<0.001 |
|
6-month pre-index healthcare utilization, N (%) |
|
|
|
|
Ambulatory visit |
1,611 (72.4%) |
34,063 (70.6%) |
0.072 |
|
Emergency department visit
|
735 (33.0%) |
8,309 (17.2%) |
<0.001 |
|
Inpatient stay
|
416 (18.7%) |
2,849 (5.9%) |
<0.001 |
|
Prescriptions
|
1,530 (68.7%) |
34,139 (70.8%) |
0.041 |
|
6-month pre-index healthcare utilization, mean (SD) |
|
|
|
|
Ambulatory visit
|
14.4 (14.9) |
7.7 (10.1) |
<0.001 |
|
Emergency department visit |
0.8 (2.2) |
0.4 (1.8) |
<0.001 |
|
Inpatient stay |
0.3 (0.7) |
0.1 (0.3) |
<0.001 |
|
Length of stay (days)
|
3.0 (14.0) |
0.6 (5.1) |
<0.001 |
|
Prescriptions |
20.2 (22.7) |
14.0 (17.7) |
<0.001 |
|
6-month pre-index cost (US$), mean (SD) |
|
|
|
|
Medical
|
$11,973 (30,262) |
$3,726 (13,750) |
<0.001 |
|
Pharmacy
|
$2,352 (5,176) |
$1,323 (3,140) |
<0.001 |
|
Total
|
$14,325 (31,605) |
$5,050 (14,585) |
<0.001 |
|
12-month post-index healthcare utilization, N (%) |
|
|
|
|
Ambulatory visit
|
1,624 (73.0%) |
37,145 (77.0%) |
<0.001 |
|
Emergency department visit |
937 (42.1%) |
15,295 (31.7%) |
<0.001 |
|
Inpatient stay |
645 (29.0%) |
7,814 (16.2%) |
<0.001 |
|
Prescriptions |
1,564 (70.3%) |
36,639 (75.9%) |
<0.001 |
|
12-month post-index healthcare utilization, mean (SD) |
|
|
|
|
Ambulatory visit
|
31.7 (31.9) |
18.5 (20.9) |
<0.001 |
|
Emergency department visit |
1.4 (3.1) |
1.0 (3.2) |
<0.001 |
|
Inpatient stay |
0.6 (1.2) |
0.2 (0.7) |
<0.001 |
|
Length of stay (days) |
5.4 (18.0) |
1.9 (11.1) |
<0.001 |
|
Prescriptions |
45.1 (48.3) |
32.9 (37.2) |
<0.001 |
|
12-month post-index cost (US$), mean (SD) |
|
|
|
|
Medical
|
$26,441 (59,035) |
$10,694 (28,543) |
<0.001 |
|
Pharmacy
|
$5,473 (12,166) |
$3,128 (6,255) |
<0.001 |
|
Total
|
$31,914 (63,450) |
$13,822 (30,492) |
<0.001 |
To cite this abstract in AMA style:
Bell CF, Blauer-Peterson C, Mao J. Burden of Illness Associated with Eosinophilic Granulomatosis with Polyangiitis (EGPA, formerly Churg-Strauss Syndrome): Evidence from a Managed Care Database in the United States [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/burden-of-illness-associated-with-eosinophilic-granulomatosis-with-polyangiitis-egpa-formerly-churg-strauss-syndrome-evidence-from-a-managed-care-database-in-the-united-states/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/burden-of-illness-associated-with-eosinophilic-granulomatosis-with-polyangiitis-egpa-formerly-churg-strauss-syndrome-evidence-from-a-managed-care-database-in-the-united-states/