Background/Purpose: Systemic sclerosis (SSc) is a chronic connective tissue disease affecting the skin and/or internal organs. Data on US economic burden of SSc is scant or old. The objective of this study was to estimate the medical costs and health care resource utilization of subjects with newly diagnosed and existing SSc in a large national US insurer.

Methods: Subjects at least 18 years of age and with claims-based evidence of SSc (ICD-9-CM 710.1x) were identified from a health plan database during 2003-2008. Subjects were divided into two cohorts; newly diagnosed and existing based on claims history of SSc. Subjects were matched using a ratio of 1:3 to unaffected controls, based on demographic and clinical characteristics. Healthcare costs and resource use were captured during a 12 month post-index period. A generalized linear model (GLM) was used to predict costs, controlling for demographic and clinical characteristics.

Results: 1,103 subjects with newly diagnosed SSc were matched to 3,309 controls, and 1,648 existing SSc subjects were matched to 4,944 controls. Mean overall annual healthcare costs were substantively higher among newly diagnosed subjects than matched controls ($18,934 vs. $5,302, p<0.001) and among existing disease subjects than matched controls ($17,365 vs. $5,508, p<0.001). Ambulatory costs were the largest driver of overall costs among both newly diagnosed and existing SSc subjects (mean annual ambulatory costs = $7,455 newly diagnosed; $6,713 existing). When adjusting for clinical and demographic characteristics (including comorbid conditions) with a GLM, the cost ratio of newly diagnosed SSc subjects to controls was 2.132 (95%CI: 1.84-2.47), and the cost ratio of subjects with existing SSc to controls was 1.988 (95%CI: 1.77-2.23). Predictors for higher costs after controlling for other variables were: evidence of lung disease, GI bleeding, renal disease, use  of systemic corticosteroids, or drugs used to treat pulmonary hypertension (PAH)(all p<0.001). Significantly higher proportions of newly diagnosed and existing SSc subjects had post-index ambulatory visits, primary care physician visits, specialist visits, emergency department visits, and inpatient hospital stays (all p<0.001) than matched controls. Of the selected medications studied, a greater proportion of SSc subjects (both newly diagnosed and existing) than controls had claims for systemic corticosteroids, methotrexate, mycophenolate mofetil, cyclophosphamide, bosentan, and sildenafil (all p<0.001).  

Conclusion: Medical costs and resource use associated with treating either new or existing SSc are high (compared to unaffected controls), and subjects with serious disease complications experience the highest costs. These findings emphasize the need to develop more effective therapeutic management strategies for multi-system diseases like SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medical-costs-and-health-care-resource-use-in-patients-with-systemic-sclerosis-in-an-insured-population/