The economic burden of tuberous sclerosis complex in the UK: A retrospective cohort study in the Clinical Practice Research Datalink.
BACKGROUND
Tuberous sclerosis complex (TSC) is a multi-system genetic disorder characterized by the development of diverse clinical manifestations. The complexity of this disease is likely to result in substantial challenges and costs in disease management throughout the patient's lifetime. This retrospective database study aims to quantify healthcare resources utilized by TSC patients.


METHODS
TSC patients in the Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database were identified between January 1987 and June 2013. Analyses were conducted over the most recent 3-year period of data and stratified by pediatric (< 18) and adult patients. Prescriptions, procedures, diagnostic tests, and healthcare encounters were reported in comparison with a matched comparator cohort. Costs and key economic drivers by primary organ system manifestations were also examined.


RESULTS
A total of 286 patients with TSC were identified and consistently reported 2-fold greater resource use than the matched presumably healthy controls. Despite this comparatively greater resource use, half of TSC patients did not record any procedures, and 20% of patients did not record any diagnostic tests; however, inpatient hospitalizations were greater for the TSC cohort (3.1 vs 1.3), but length of stay was comparable. TSC patients had costs totaling £12,681 per patient over the 3-year period, a figure 2.7-fold greater than the total costs in the comparator cohort (£4,777). Costs for patients with specific primary manifestations were even greater, with brain manifestations incurring £22,139 per affected patient. Kidney and nervous system manifestations were the main cost drivers.


CONCLUSIONS
The economic burden of TSC and its impact on NHS healthcare resources is mostly attributable to the broad spectrum of manifestations that develop within multiple organ systems. TSC patients may benefit from co-ordinated care based on their requirement for high numbers of healthcare visits across specialties.
a The Royal Sussex County Hospital , Brighton , UK.
John C
JC
Kingswood
b York Hospital , York , UK.
Pamela
P
Crawford
c University of Nottingham , Nottingham , UK.
Simon R
SR
Johnson
d Institute of Medical Genetics, Cardiff University School of Medicine , Cardiff , UK.
Julian R
JR
Sampson
e Nobles Hospital , Isle of Man , UK.
Charles
C
Shepherd
f IMS Health , London , UK.
Dirk
D
Demuth
g CE Analytics , Cambridge , UK.
Clement
C
Erhard
f IMS Health , London , UK.
Paola
P
Nasuti
f IMS Health , London , UK.
Keyur
K
Patel
f IMS Health , London , UK.
Melissa
M
Myland
h Novartis Pharmaceuticals, UK Ltd , Frimley , UK.
Alun
A
Pinnegar
i Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
Matthew
M
Magestro
h Novartis Pharmaceuticals, UK Ltd , Frimley , UK.
Elizabeth
E
Gray
D000293:Adolescent; D000328:Adult; D000368:Aged; D035843:Biomedical Research; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D016208:Databases, Factual; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014402:Tuberous Sclerosis / Q000175:diagnosis / Q000191:economics*; D006113:United Kingdom; D055815:Young Adult
CPRD; Cost; HES; Healthcare resource use; Tuberous sclerosis complex