The cost of glucocorticoid-associated adverse events in rheumatoid arthritis.
OBJECTIVE
To estimate the costs of glucocorticoid associated adverse events (GAEs) in patients with rheumatoid arthritis (RA).


METHODS
We conducted a literature review of studies reporting GAEs in RA patients, and developed a Markov model with the following GAEs: fractures (vertebral, hip, pelvic), hypertension, diabetes, gastrointestinal complications, pneumonia, urinary tract infection, cataract and, in an extended model, myocardial infarction (MI) and stroke. Two-year total costs were calculated using direct medical costs (2001 US dollars [USD]) and by running 10,000 Monte Carlo simulations with probability values randomly selected from the GAE literature.


RESULTS
On average, glucocorticoid users spent USD 445 more than non-users, or USD 0.46 for each dollar spent on purchasing the drug. When adding MI and stroke, users spent on average USD 430 more than non-users, or USD 0.44 for each dollar spent on purchasing the drug; this incremental cost ranged from USD 193 to USD 682 if MI and stroke were excluded, respectively. In 70% of the simulations there were more deaths among users than among non-users, in both the model with and without MI and stroke.


CONCLUSIONS
Although results varied depending on attributed GAEs, in general glucocorticoid users spent more than non-users on GAE treatment, and had higher mortality. Patients, providers and policy makers should consider these potential costs of GAEs when making treatment decisions.
Pisu
M
M
Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1530 3rd Avenue North, Birmingham, AL 35294-3408, USA.
James
N
N
Sampsel
S
S
Saag
K G
KG
D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017281:Cost of Illness; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics; D005938:Glucocorticoids / Q000009:adverse effects* / Q000191:economics; D006801:Humans; D008390:Markov Chains; D009010:Monte Carlo Method; D009203:Myocardial Infarction / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics; D011014:Pneumonia / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics; D020521:Stroke / Q000150:complications / Q000188:drug therapy / Q000191:economics
D005938:Glucocorticoids