title: Evaluation of health care costs and utilization patterns for patients with gout.
abstract: BACKGROUND
  The prevalence of gout has been increasing. Serum uric acid (sUA) levels ≥6 mg/dL have been associated with high morbidity and increased health care utilization.
  
  
  OBJECTIVE
  To assess the costs and patterns of health care resource utilization for patients with gout, categorized into 3 cohorts based on sUA levels.
  
  
  METHODS
  We retrospectively analyzed laboratory, pharmacy, and medical service claims data (January 2005 to June 2010) for patients ≥18 years old. Inclusion criteria were at least 2 sUA levels and at least 1 primary gout diagnosis (International Classification of Disease-9th revision code 274.xx), and/or at least 1 prescription for gout-specific medications. Outcomes including costs, health care resource utilization, and medication adherence and persistence were assessed for the 1-year postindex period and summarized for the 3 cohorts based on sUA levels: <6 mg/dL, 6 to 8.99 mg/dL, and ≥9 mg/dL. Costs were adjusted based on preindex utilization and baseline characteristics.
  
  
  RESULTS
  Three hundred fifty-two patients met the inclusion criteria: cohort 1 (sUA <6 mg/dL), n = 38, mean age 59 years; cohort 2 (sUA 6-8.99 mg/dL), n = 231, mean age 61 years; and cohort 3 (sUA ≥9 mg/dL), n = 83, mean age 62 years. Mean adjusted gout-related health care costs were $332, $353, and $663, respectively (P <0.05); mean adjusted all-cause health care costs were $11,365, $11,551, and $14,474, respectively, for the 3 cohorts (P <0.05). sUA levels were positively associated with the percent of patients who had at least 1 hospitalization and the mean number of hospitalizations and emergency department visits (P < 0.05). Significantly more patients with sUA <6 mg/dL achieved adherence rates of ≥80% and had a longer mean duration of continuous treatment compared with patients with sUA between 6 and 8.99 mg/dL or ≥9.0 mg/dL (P <0.05).
  
  
  CONCLUSIONS
  Patients with high levels of sUA had higher gout-related and all-cause health care costs, more all-cause hospitalizations, and emergency department visits, but they also exhibited poorer adherence and persistence.
authors.affiliation: Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, Texas, USA.
authors.forename: Haesuk
authors.initials: H
authors.lastname: Park
authors.forename: Karen L
authors.initials: KL
authors.lastname: Rascati
authors.forename: Karim
authors.initials: K
authors.lastname: Prasla
authors.forename: Tyrone
authors.initials: T
authors.lastname: McBayne
mesh_terms: D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy / Q000191:economics*; D006074:Gout Suppressants / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D013781:Texas; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid