title: Comorbidity burden, healthcare resource utilization, and costs in chronic gout patients refractory to conventional urate-lowering therapy.
abstract: Patients with chronic gout refractory to conventional urate-lowering therapy have high rates of flares and incidence of tophi, which impose a significant disease and potentially economic burden. This study examined healthcare resource use and costs stratified by disease burden. Adult patients diagnosed with gout (ICD-9-CM:274.xx) and having had ≥3 flares defined by clinical surrogates within a 12-month period were selected for the case cohort from the Thomson MarketScan databases (2003/Q3-2008/Q3). Only patients who had received allopurinol treatment and a diagnosis of tophi (ICD-9-CM:274.8x) at any time before the first flare (index date) or within 12 months postindex were included and were matched in a 1:1 ratio with control gout-free subjects. The comorbidity burden, healthcare resource use, and annual healthcare costs (2008 US$) in the 12-month postindex period were compared between both cohorts using regression models adjusted for demographic characteristic and stratified for patients with ≥6 flares. A total of 679 gout patients met the inclusion criteria for the study and had a higher prevalence of comorbidities than their matched controls. Gout cohort had a significantly higher incidence of emergency room, hospitalizations, outpatient visits, and other medical services than did their matched controls (all comparisons, uncorrected P < 0.01). After adjusting for baseline characteristics, the refractory gout cohort incurred an incremental total annual healthcare cost of $10,222 where 40% of the annual medical cost was for gout-related care compared with control cohort (P < 0.01). Patients with refractory gout have a significant economic burden compared with a gout-free population.
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Anna
authors.initials: A
authors.lastname: Forsythe
authors.forename: Annie
authors.initials: A
authors.lastname: Guérin
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Yu
authors.forename: Dominick
authors.initials: D
authors.lastname: Latremouille-Viau
authors.forename: Magda
authors.initials: M
authors.lastname: Tsaneva
mesh_terms: D000328:Adult; D000493:Allopurinol / Q000627:therapeutic use; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D017281:Cost of Illness; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006073:Gout / Q000191:economics* / Q000473:pathology / Q000628:therapy; D006074:Gout Suppressants / Q000627:therapeutic use; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D006074:Gout Suppressants; D000493:Allopurinol