Economic burden of sarcoidosis in a commercially-insured population in the United States

Figures & data

Figure 1. Selection of sarcoidosis patients and non-sarcoidosis controls. (1) The index date for the Control Cohort was defined as a randomly selected medical claim occurring during the study period. (2) The outcome period is defined as the 12-month period beginning on the index date. (3) A greedy matching algorithm was used to match each sarcoidosis patient with a control patient, based on propensity score and Charlson Comorbidity Index (CCI), a composite measure of the patient’s health status. Propensity scores were estimated using a multivariate logistic regression with the following covariates (measured during the 12-month period preceding the index date): age, gender, region, index year (categorical variable), number of medical visits (inpatient, outpatient, emergency department, other), number of prescriptions filled, medical costs, and prescription drug costs. Matched pairs were required to have the same CCI score and availability of work loss data.

Table 1. Patient characteristics, resource utilization, and healthcare costs during the 12 months prior to the index date.

	Pre-match					Post-match
	Sarcoidosis cohort		Control cohort			Sarcoidosis cohort		Control cohort
	(n = 7,173)		(n = 257,090)		Standardized difference vs Controls^a	(n = 7,119)		(n = 7,119)		Standardized difference vs Controls^a
Demographics
Age (year), mean (SD)	49.4	(9.6)	43.4	(12.9)	0.47	49.4	(9.7)	50.3	(10.4)	−0.10
Male, %	41.4%	(2,972)	48.6%	(125,026)	−0.14	41.5%	(2,951)	43.0%	(3,058)	−0.03
Year of index date, % (n)
2004 or earlier	25.5%	(1,826)	18.7%	(48,120)	0.17	25.4%	(1,806)	23.7%	(1,687)	0.04
2005–2007	22.8%	(1,637)	18.9%	(48,712)	0.10	22.8%	(1,620)	23.0%	(1,639)	−0.01
2008–2010	24.3%	(1,742)	23.4%	(60,193)	0.02	24.3%	(1,730)	24.3%	(1,730)	0.00
2011–2014 (Q1 only)	27.4%	(1,968)	38.9%	(100,065)	−0.24	27.6%	(1,963)	29.0%	(2,063)	−0.03
US census division, % (n)
New England	7.1%	(511)	5.9%	(15,234)	0.05	7.1%	(508)	6.7%	(477)	0.02
Middle Atlantic	17.2%	(1,237)	12.9%	(33,102)	0.13	17.1%	(1,220)	16.9%	(1,201)	0.01
East North Central	18.6%	(1,331)	15.4%	(39,595)	0.09	18.5%	(1,319)	18.9%	(1,346)	−0.01
West North Central	5.5%	(396)	8.4%	(21,584)	−0.10	5.5%	(392)	6.0%	(425)	−0.02
South Atlantic	21.7%	(1,558)	19.0%	(48,868)	0.07	21.7%	(1,547)	21.9%	(1,558)	0.00
East South Central	6.9%	(492)	6.0%	(15,429)	0.04	6.9%	(490)	6.7%	(478)	0.01
West South Central	8.7%	(625)	12.1%	(31,176)	−0.10	8.8%	(623)	8.3%	(592)	0.02
Mountain	4.1%	(294)	7.0%	(17,890)	−0.11	4.1%	(294)	4.5%	(323)	−0.02
Pacific	5.4%	(385)	9.1%	(23,308)	−0.13	5.4%	(383)	5.5%	(392)	−0.01
Unknown	4.8%	(344)	4.2%	(10,904)	0.03	4.8%	(343)	4.6%	(327)	0.01
Comorbidities
Charlson Comorbidity Index, mean (SD)	0.9	(1.5)	0.3	(0.9)	0.68	0.9	(1.4)	0.9	(1.4)	0.00
Chronic comorbidities, % (n)
Chronic pulmonary disease	18.8%	(1,347)	6.3%	(16,103)	0.51	18.5%	(1,315)	13.7%	(977)	0.13
Rheumatic disease	6.0%	(432)	1.0%	(2,626)	0.47	5.8%	(415)	2.7%	(191)	0.16
Liver disease, mild	4.7%	(335)	1.6%	(4,023)	0.24	4.5%	(323)	4.0%	(285)	0.03
Cerebrovascular disease	3.5%	(250)	1.4%	(3,655)	0.17	3.4%	(244)	4.1%	(291)	−0.03
Congestive heart failure	3.4%	(246)	0.9%	(2,353)	0.26	3.3%	(237)	3.0%	(216)	0.02
Renal disease	2.3%	(166)	0.7%	(1,839)	0.18	2.2%	(155)	2.8%	(196)	−0.04
Healthcare resource use, mean (SD)
Medical visits	19.2	(19.3)	10.9	(14.2)	0.58	18.6	(17.7)	17.7	(19.2)	0.05
Inpatient	0.4	(2.0)	0.1	(0.7)	0.30	0.3	(0.9)	0.3	(0.9)	0.03
Outpatient/physician office	15.5	(15.7)	8.9	(11.9)	0.54	15.0	(14.5)	14.4	(15.6)	0.04
Emergency department	0.7	(1.6)	0.4	(1.2)	0.25	0.7	(1.4)	0.6	(1.7)	0.06
Other visits	2.6	(5.5)	1.4	(4.1)	0.29	2.6	(5.3)	2.4	(6.1)	0.02
Number of prescriptions filled	21.7	(25.5)	11.7	(17.0)	0.58	21.1	(24.0)	21.3	(24.8)	−0.00
Healthcare costs,^b mean (SD)
Total healthcare costs	$14,608	($35,586)	$6,200	($24,580)	0.34	$13,840	($32,850)	$13,692	($35,738)	0.01
Medical costs	$12,360	($33,895)	$5,123	($23,729)	0.30	$11,710	($31,555)	$11,534	($34,554)	−0.01
Prescription drug costs	$2,247	($6,352)	$1,077	($3,787)	0.30	$2,130	($5,469)	$2,158	($5,255)	0.00

^a The standardized difference compares the difference in means or proportions across the two cohorts in units of the pooled standard deviation. An absolute value of standardized difference >0.10 is considered a meaningful imbalance between groups.

^b Costs inflated to 2015 USD using the medical care component of the Consumer Price Index.

Table 2: Healthcare resource utilization and costs during the 12 months following the index date among matched sarcoidosis patients and controls.

	Sarcoidosis cohort		Control cohort
	(n = 7,119)		(n = 7,119)		Relative difference(Sarco/Control)	p-value^a
Sarcoidosis-related comorbidities, % (n)
Essential (primary) hypertension	35.3%	(2,516)	32.0%	(2,275)	10.6%	<0.001
Chronic pulmonary disease	21.2%	(1,508)	11.6%	(824)	83.0%	<0.001
Interstitial lung disease	20.8%	(1,478)	2.5%	(181)	716.6%	<0.001
Cardiac arrhythmia	9.0%	(639)	6.4%	(454)	40.7%	<0.001
Cataracts	6.9%	(488)	5.1%	(364)	34.1%	<0.001
Myalgia and myositis	6.6%	(471)	4.3%	(306)	53.9%	<0.001
Pneumonia	6.5%	(466)	2.9%	(206)	126.2%	<0.001
Uveitis	5.1%	(362)	0.4%	(30)	1,106.7%	<0.001
Hypercalcemia	2.0%	(140)	0.5%	(35)	300.0%	<0.001
Erythema nodosum	1.3%	(93)	0.0%	(1)	9,200.0%	<0.001
All-cause healthcare use
Medical visits, mean (SD)	23.3	(21.2)	19.1	(20.8)	22.0%	<0.001
Inpatient	0.4	(1.1)	0.3	(1.1)	36.8%	<0.001
Outpatient/physician office	18.8	(16.4)	15.3	(16.3)	22.5%	<0.001
Emergency department	0.7	(1.6)	0.6	(1.9)	14.6%	<0.001
Other visits	3.4	(7.9)	2.9	(7.6)	19.4%	<0.001
Number of prescriptions filled, mean (SD)	25.5	(27.3)	22.4	(25.5)	14.2%	<0.001
≥1 specialist visit, % (n)
Radiologist	74.3%	(5,289)	51.8%	(3,686)	43.5%	<0.001
Pulmonologist	38.3%	(2,728)	5.1%	(362)	653.6%	<0.001
Ophthalmologist	29.3%	(2,085)	15.2%	(1,081)	92.9%	<0.001
Cardiologist	28.7%	(2,045)	19.7%	(1,401)	46.0%	<0.001
Dermatologist	21.9%	(1,561)	17.1%	(1,220)	28.0%	<0.001
Gastroenterologist	15.8%	(1,126)	13.7%	(977)	15.3%	<0.001
Rheumatologist	13.4%	(953)	3.2%	(228)	318.0%	<0.001
Nephrologist	3.9%	(277)	3.1%	(218)	27.1%	0.005
All-cause healthcare costs,^b mean (SD)
Medical costs	$16,992	($48,436)	$12,055	($39,443)	41.0%	<0.001
Inpatient	$6,398	($37,237)	$4,500	($27,094)	42.2%	<0.001
Outpatient/physician office	$9,050	($20,925)	$6,296	($20,168)	43.7%	<0.001
Emergency department	$603	($2,550)	$446	($1,874)	35.3%	<0.001
Other visits	$942	($8,557)	$814	($8,070)	15.7%	<0.001
Prescription drug costs	$2,722	($7,237)	$2,469	($6,104)	10.2%	<0.001
Total healthcare costs	$19,714	($50,264)	$14,524	($41,166)	35.7%	<0.001

^a Post-match p-values were calculated using Wilcoxon signed-rank tests for continuous variables and McNemar tests for categorical variables.

^b Costs inflated to 2015 USD using the medical care component of the Consumer Price Index.

Table 3. Work loss and work loss costs during the 12 months following the index date among matched sarcoidosis patients and controls^a,b.

	Sarcoidosis cohort (n = 1,922)		Control cohort (n = 1,922)		Relative difference(Sarco/Control)	p-value^c
Work loss
Any work loss day, % (n)	99.9%	(1,920)	99.5%	(1,913)	0.4%	0.035
Disability	8.6%	(166)	6.0%	(116)	43.1%	0.002
Medically-related absenteeism	98.1%	(1,885)	98.4%	(1,892)	−0.4%	0.385
Number of work loss days, mean (SD)	15.9	(38.2)	11.3	(30.0)	41.4%	<0.001
Disability days	7.5	(38.4)	4.6	(29.4)	63.3%	0.001
Medically-related absenteeism	8.4	(8.4)	6.7	(7.0)	26.3%	<0.001
Work loss costs^d
Total work loss costs, mean (SD)	$3,288	($6,089)	$2,527	($5,180)	30.1%	<0.001
Disability	$971	($5,234)	$627	($4,405)	54.9%	<0.001
Medically-related absenteeism	$2,316	($3,440)	$1,900	($2,742)	21.9%	<0.001

^a Analyses limited to primary beneficiaries who had work loss data available for the entirety of the 12-month outcome period.

^b Medically-related absenteeism was calculated using medical claims occurring during the workweek. Days with a hospitalization or emergency department visit were counted as a full day of absenteeism, and all other visits were counted as a half day of absenteeism. Medically-related absenteeism costs were imputed by multiplying the number of days of missed work by the daily benefits received (disability) or wage (absenteeism).

^c Post-match p-values were calculated using Wilcoxon signed-rank tests for continuous variables and McNemar tests for categorical variables.

^d Costs inflated to 2015 USD using the all items component of the Consumer Price Index.

Figure 2. Total and incremental economic burden of sarcoidosis among adults with commercial insurance in the US. (1) Total and incremental economic burden was estimated for the US population of adults with commercial insurance between the ages of 18–64), inclusively. Estimates of burden are presented in 2015 USD. (2) Calculations rely on the following assumptions: (a) Prevalence rates range from 48–330 sarcoidosis cases/100,000 persons²⁵; (b) US population of persons between the ages of 18–64 is 199.0 million (US Census Bureau 2014); (c) 67.3% of persons between the ages of 18–64 in the US are covered by commercial insurance (National Center for Health Statistics 2015); (d) Total healthcare cost for sarcoidosis is $19,714, and incremental healthcare cost is $5,190, based on the results of the annual cost analysis in the matched cohort.

Birnbaum ADFD, Mirsaeidi M, Wehrli S. Sarcoidosis in the national veteran population: Association of ocular inflammation and mortality. Opthalmology 2015;122:934-8

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