title: Comparison of patient characteristics and gout-related health-care resource utilization and costs in patients with frequent versus infrequent gouty arthritis attacks.
abstract: OBJECTIVE
  To examine the association between frequent gouty arthritis and the presence of absolute/relative contraindications to gout therapies, and health-care expenditure associated with frequent gouty arthritis.
  
  
  METHODS
  This retrospective study used administrative claims to identify patients with gouty arthritis between 1 July 2005 and 30 June 2010. Patients with ≥3 yearly gouty arthritis attacks (frequent gout) were matched 1:2 to patients with <3 yearly attacks (infrequent gout). Absolute and relative contraindications to gout medications were evaluated based on product labelling. Negative binomial regression and generalized linear models with logarithmic transformation were used for multivariate analysis of overall and gout-related health-care use and cost.
  
  
  RESULTS
  Mean patient age was 58 years (n = 15 669) and 77% were men. Compared with patients with infrequent gout, those with frequent gout had higher rates of absolute/relative contraindications to NSAIDs (91.5% vs 78.7%, P < 0.0001), corticosteroids (96.4% vs 87.3%, P < 0.0001), allopurinol (51.0% vs 41.2%, P < 0.0001) and probenecid (13.4% vs 9.4%, P < 0.0001). Mean gout-related costs were $889 for frequent gout vs $210 for infrequent gout (P < 0.0001) and all-cause direct costs were $10 913 for frequent vs $10 685 for infrequent gout (P = ns). Mean all-cause outpatient visits among patients with comorbidities compared with those without were 25.8 vs 11.8 among frequent and 19.7 vs 9.0 among infrequent (both P < 0.001) groups. Gout-related costs were higher among frequent gout patients with comorbidities than those without comorbidities ($886 vs $513, P = 0.03).
  
  
  CONCLUSIONS
  Patients with frequent gouty arthritis are likely to have absolute and/or relative contraindications to gout medications and higher gout-related treatment costs.
authors: University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E. Montview Blvd, V20-2126, Aurora, CO 80045, USA. joseph.saseen@ucdenver.edu
authors: Joseph J
authors: JJ
authors: Saseen
authors: Neetu
authors: N
authors: Agashivala
authors: Richard Read
authors: RR
authors: Allen
authors: Vahram
authors: V
authors: Ghushchyan
authors: Anthony M
authors: AM
authors: Yadao
authors: Kavita V
authors: KV
authors: Nair
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000191:economics; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics; D015210:Arthritis, Gouty / Q000188:drug therapy* / Q000191:economics; D003120:Colorado; D000075202:Contraindications; D003365:Costs and Cost Analysis; D005260:Female; D006074:Gout Suppressants / Q000191:economics; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants