Direct and indirect economic and health consequences related to sarcoidosis in Denmark: A national register-based study

Abstract

Background: Sarcoidosis is a systemic disease that primarily affects the younger population. Longitudinal studies of the economic burden of sarcoidosis are scarce. This study evaluates overall the economic burden of sarcoidosis in Denmark before and after initial diagnosis. Methods: We identified patients with sarcoidosis in the Danish National Patient Registry (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). All controls were randomly selected and matched concerning age, gender and residence. Data on direct and indirect costs, including frequency of primary and secondary sector contacts and procedures, medication, unemployment benefits and social transfer payments were extracted from national databases for patients and controls. Results: We identified 9119 patients with sarcoidosis and 36,432 matching controls. Patients with sarcoidosis had significantly higher rates of health-related contacts, higher usage of medication and more received unemployment and social payments compared with controls.The total health expenses were significantly higher in the sarcoidosis group 11 years before and 11 years after diagnosis than among controls.Income from public transfer payments was significantly higher in the sarcoidosis group five years prior of diagnosis until nine years post diagnosis. Especially women between 40 and 59 years have a lower income than their controls. Conclusion: Sarcoidosis has a socioeconomic impact on adults especially during their prime working and providing years and this is evident several years prior to and post diagnosis. The authors advocate that further research should focus on identifying the proportion of patients with sarcoidosis that imposes the largest economic burden. Increased focus on early diagnosis and disease management may reduce the socioeconomic burden of sarcoidosis.

Sarcoidosis diagnosis and treatment in Sweden: A register-based assessment of variations by region and calendar period

“…Long-lasting preclinical sarcoidosis was described in several other studies. Comparing sick leave absence, earnings, and health expenses as indicators of general health status between sarcoidosis and nonsarcoidosis comparators, large studies from Sweden [3] and Denmark [6] indicate that preclinical disease might last for at least a year. Using employer health insurance data from the United States, an investigation found more outpatient visits during the year before diagnosis in sarcoidosis compared to other pulmonary diseases [5].…”

“…Sarcoidosis, a granulomatous disease of unknown etiology, may present in multiple forms and affect several organs [1,2]. As a result and in the absence of a pathognomonic test, diagnosis is often a long and complex process involving invasive examinations and exclusion of alternative diagnoses [2][3][4][5][6]. According to international and Swedish recommendations, pharmacologic treatment, initially systemic corticosteroids that are replaced thereafter by steroid-sparing agents, is reserved for patients with debilitating symptoms or progressive disease [7][8][9].…”

Diversity and disparity in the treatment and care of sarcoidosis

“…Furthermore, patients with sarcoidosis were less likely to be employed and more likely to be receiving unemployment and social benefits beginning 5 years prior to diagnosis and extending up to 9 years after diagnosis [81]. Patients aged 40–64 years had the lowest income from employment (relative to controls) [81]. Data from the United States presents similar findings [40 ▪▪ ,84].…”

“…Sikjaer et al [81] found that the total health expenses for patients with sarcoidosis was significantly higher than for population-based controls beginning 11 years before and extending up to 11 years after diagnosis. Furthermore, patients with sarcoidosis were less likely to be employed and more likely to be receiving unemployment and social benefits beginning 5 years prior to diagnosis and extending up to 9 years after diagnosis [81]. Patients aged 40-64 years had the lowest income from employment (relative to controls) [81].…”

Cost drivers in the pharmacological treatment of interstitial lung disease

“…Most evidence corresponding to the economic burden of ILDs is however restricted to distinct service providers (e.g. hospital costs) [ 16 ], focused on pre-selected ILD subtypes [ 17 , 18 ] or took a cross-sectional perspective on costs of care [ 14 ]. A comprehensive assessment on costs associated with drug treatment that accounts for potentially different trends in various ILDs is lacking so far.…”