title: Healthcare costs and utilization for privately insured patients treated for non-infectious uveitis in the USA.
abstract: BACKGROUND
  The purpose of this study was to describe comorbidities, healthcare costs, and resource utilization among patients with chronic non-infectious uveitis initiating corticosteroid, immunosuppressants, or biologics.In this retrospective cohort study, patients with a non-infectious uveitis diagnosis and continuous insurance coverage during a 6-month baseline were selected from a privately insured claims database with 80.7 million enrollees. Index dates were defined as the first prescription/administration of a corticosteroid, immunosuppressant, or biologic between 2003 and 2009. Comorbidities, healthcare costs, and utilization were analyzed in a per-member-per-month (PMPM) framework to account for varying between-patient treatment periods, defined as continuous medication use within the same class. Wilcoxon rank-sum and chi-square tests were used for comparisons of costs and categorical outcomes.
  
  
  RESULTS
  Patients on corticosteroids (N = 4,568), immunosuppressants (N = 5,466), and biologics (N = 1,694) formed the study population. Baseline PMPM inpatient admission rates were 0.029 for patients on corticosteroids, 0.044 for patients on immunosuppressants, and 0.045 for patients on biologics (p < 0.001 immunosuppressants or biologics versus corticosteroids); during treatment, PMPM inpatient admissions increased to 0.044 and 0.048 for patients taking corticosteroids and immunosuppressants, respectively, but decreased to 0.024 for patients taking biologics (p < 0.001 versus corticosteroids and p = 0.003 versus immunosuppressants). Baseline average PMPM costs for patients taking corticosteroids, immunosuppressants, and biologics were US$935, US$1,738, and US$1,439 (p < 0.001 between groups), while on-treatment PMPM costs excluding drug costs increased to US$1,129 for patients taking corticosteroids but lowered to US$1,592 for patients taking immunosuppressants, and US$918 for patients taking biologics (p < 0.001 versus corticosteroids or immunosuppressants).
  
  
  CONCLUSIONS
  There is significant economic burden associated with existing treatments of uveitis. Corticosteroids may be overused as a treatment for uveitis.
authors.affiliation: Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, 90 Bergen Street, Suite 6100, Newark, NJ 07960, USA. chuda@njms.rutgers.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Chu
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Johnson
authors.forename: Usha G
authors.initials: UG
authors.lastname: Mallya
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Davis
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Sorg
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh