Healthcare resource use and cost associated with varying dosages of extended corticosteroid exposure in a US population

Abstract

Aims: To quantify healthcare resource use (HCRU) and costs associated with varying levels of corticosteroid exposure.

Materials and methods: Patients with a diagnosis of selected autoimmune and inflammatory diseases between 1 January 2006 and 30 September 2015 (“study period”) were selected from a de-identified, privately-insured claims database. Patients were stratified into four treatment cohorts based on the dosing and duration of continuous corticosteroid use following disease diagnosis: intermittent use with <60 days of corticosteroid use and ≥60 days of corticosteroid use with low (≤7.5 mg/day), medium (>7.5–≤15 mg/day), or high (>15 mg/day) dosage. Patients were followed from the date of their highest dose episode of corticosteroid use (“treatment index date”) until the earliest of the end of continuous corticosteroid use +30 days, disenrollment from health plan, or the end of the study period (“follow-up period”). HCRU and costs in the follow-up period were compared across treatment cohorts.

Results: Of 78,704 patients who were identified for study inclusion, 29% had extended corticosteroid use lasting ≥60 days, and 71% had intermittent use. On average, patients in the high-dose cohort incurred twice the cost of intermittent users ($68,408 vs $32,690 in annualized total all-cause healthcare costs, USD). Adverse event-related medical costs accounted for ∼40% of medical costs, and were higher than disease-related medical costs for all cohorts with extended corticosteroid exposure. Comparing the high-dose and low-dose cohorts, the smaller savings in disease-related prescriptions ($1,680) occurred along with a much larger cost in adverse event-related spend ($13,464).

Limitations: The impact of corticosteroids may be under-estimated because of conservative follow-up duration, and administrative data may contain inaccuracies in coding.

Conclusions: Steroid use, especially at higher doses, is associated with higher HCRU and costs.

Keywords:

• Extended corticosteroid exposure
• corticosteroids
• healthcare resource use
• costs
• dose-dependent response

JEL classification codes:

• I00
• I19

Transparency

Declaration of funding

This study was sponsored by Mallinckrodt Pharmaceuticals, Inc., Bedminster, NJ.

Declaration of financial/other relationships

YQ, LBP, GC, and WWN are employees of Mallinckrodt Pharmaceuticals, which provided research funding to Analysis Group, Inc. (employer of JBR, AGW, MJ, and AW). Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

No assistance in the preparation of this article is to be declared.

Previous presentations

Abstracts containing results from this analysis were presented at the 2017 American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting, 3–8 November 2017, San Diego, CA.