Session Information
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:
- Brown LE, et al. Rheumatology (Oxford) 2015;54:816–20.
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Table 1. Baseline Characteristics and Comorbidities by Cohort |
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|
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 (%) |
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|
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 |
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CCI=Charlson Comorbidity Index; COPD=chronic obstructive pulmonary disease; pt=patient; sSS=secondary Sjögren’s syndrome; SLE=systemic lupus erythematosus |
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Table 2. Healthcare Resource Utilization During the 12-Month Pre-Index Period and 12-Month Post-Index Period for the sSS Cohort |
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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 (%) |
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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 |
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Number of healthcare services utilized, mean (SD) |
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|
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 |
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Pharmacy prescriptions |
44.1 (35.3) |
53.5 (37) |
<0.0001 |
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sSS=secondary Sjögren’s syndrome |
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Table 3. Healthcare Resource Utilization During the 12-Month Post-Index Period |
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|
|
Pts with RA with sSS (n=1858) |
Pts with RA without sSS (n=21,264) |
p value |
|
Number of patients utilizing healthcare services, n (%) |
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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 |
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Number of healthcare services utilized, mean (SD) |
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|
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 |
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sSS=secondary Sjögren’s syndrome |
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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 .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - 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/