title: Sjögren's syndrome: managed care data from a large United States population highlight real-world health care burden and lack of treatment options.
abstract: OBJECTIVE
  To better understand the real-world characteristics and costs of Sjögren's syndrome (SS).
  
  
  METHODS
  Analysing the MarketScan Commercial Claims database from Jan. 1, 2006 to Dec. 31, 2011, we identified 10,414 patients ≥18 years old newly diagnosed with SS. Patient characteristics, drugs (commonly used for SS), resource utilisation, and medical costs were evaluated for 12 months pre- and post-diagnosis.
  
  
  RESULTS
  Mean age was 55 years; 90% were female. At diagnosis, SS patients were most often seen by rheumatologists (39%) or internists (14.2%); the most common concurrent autoimmune conditions were rheumatoid arthritis (17.9%) and systemic lupus erythematosus (14.6%). Other common comorbidities were hypertension (37.6%), osteoarthritis (31.4%), and hyperlipidaemia/dyslipidaemia (30.3%). Post diagnosis of SS, claims for myocardial infarction and coronary artery bypass graft doubled. Medications of interest prescribed post-diagnosis were eye/mouth drugs (32.2%) and synthetic immunosuppressants (32.1%). Biologic drugs were prescribed to a minority (TNF inhibitors, ~5.0%; non-TNF inhibitors, 1%). Of note, prescriptions for all systemic immunotherapies (synthetic and biologic) were significantly lower in the subgroup without concurrent autoimmune disease, and 15.1% of the overall population had no SS-related prescriptions. Post diagnosis, total medical resource utilisation and total medical costs increased (1.2 and 1.4-fold, respectively).
  
  
  CONCLUSIONS
  In this retrospective, real-world analysis, medical claims in the first year after SS diagnosis revealed that cardiovascular (CV) events increased and all-cause healthcare costs grew by 40%. Pharmacologic management consisted primarily of low potency immunomodulation and symptomatic treatments. Systemic disease-modifying therapies were used mostly in patients who had another concurrent autoimmune disease, suggesting a lack of treatment options for SS.
authors.affiliation: Lilly Corporate Center, Indianapolis, IN, USA. j.birt@lilly.com.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Birt
authors.affiliation: Lilly Biotechnology Center, San Diego, CA, USA.
authors.forename: YingMeei
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Lilly Biotechnology Center, San Diego, CA, USA.
authors.forename: Neelufar
authors.initials: N
authors.lastname: Mozaffarian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012859:Sjogren's Syndrome / Q000188:drug therapy*; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products