Healthcare utilization and expenditures for United States Medicare beneficiaries with systemic vasculitis

Thorpe, Carolyn T.; Thorpe, Joshua M.; Jiang, Tao; Atkinson, Dylan; Kang, Yihuang; Schleiden, Loren J.; Carpenter, Delesha M.; McGregor, Julie Anne G.; Hogan, Susan L.

doi:10.1016/j.semarthrit.2017.08.005

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…Systemic vasculitis, including AAV, is associated with increased healthcare costs due to increases in hospital care and expensive medications [ 4 , 38 , 39 ]. Biological therapies used for relapsing AAV cost in excess of £6000 annually per patient.…”

Section: Discussionmentioning

confidence: 99%

The HAVEN study—hydroxychloroquine in ANCA vasculitis evaluation—a multicentre, randomised, double-blind, placebo-controlled trial: study protocol and statistical analysis plan

Learoyd

Arnold

Reid

et al. 2023

Trials

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Background Patients with non-severe ANCA-associated vasculitis (AAV) are often prescribed immunosuppressive medications that are associated with severe side effects and a reduced quality of life. There is an unmet need for safer effective treatments for these patients. Hydroxychloroquine is being explored due to its effect in similar autoimmune conditions such as systemic lupus erythematosus. Methods Double-blind, placebo-controlled multicentre trial recruiting 76 patients across 20 sites. Participants will be randomised 1:1 to hydroxychloroquine or placebo in addition to standard of care immunosuppressive therapies over the course of 52 weeks. A phase II selection design will be used to determine hdroxychloroquine’s efficacy, using prednisolone dosage and Birmingham Vasculitis Activity Score as a measure of disease activity. Secondary outcomes will explore other elements of AAV progression, including disease flares and time to remission. Discussion This trial aims to explore Hydroxychloroquine as a treatment for patients with AAV. If effective, the need for immunosuppressive treatments such as prednisolone could be reduced. Hydroxychloroquine is safer, cheaper and has fewer adverse effects than conventional immunosuppressive treatments. This could improve patient outcomes while saving money for the NHS. Trial registration ISRCTN: ISRCTN79334891. Registered 07 June 2021. EudraCT: 2018-001268-40. Registered 13 September 2019. Clinicaltrials.gov: NCT04316494. Registered 20 March 2020.

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Section: Discussionmentioning

confidence: 99%

The HAVEN study—hydroxychloroquine in ANCA vasculitis evaluation—a multicentre, randomised, double-blind, placebo-controlled trial: study protocol and statistical analysis plan

Learoyd

Arnold

Reid

et al. 2023

Trials

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“…Systemic lupus erythematosus (ICD‐9: 710.0 or ICD‐10: M32.1) was defined by ≥3 inpatient or outpatient diagnoses, each at least 30 days apart 19 . Morphoea (ICD‐9: 701.0 or ICD‐10: L94.0, L94.1, L94.3), systemic sclerosis (ICD‐9: 710.1 or ICD‐10 M34.x), Sjogren’s syndrome (ICD‐9: 710.2 or ICD‐10: M35.0x) and systemic vasculitis (ICD‐9: 446.5, 446.7, 446.0, 446.1, 446.4, 287.0, 446.21, 447.6 or ICD‐10: M30.0, M30.1, M31.x or ICD‐10: M31.5, M31.6, M31.4, M30.0, M31.3x, M30.1, D69.0, M31.0, M31.7) were each defined by ≥1 inpatient diagnosis or ≥2 outpatient diagnoses at least 60 days apart but within 2 years or ≥1 diagnosis by a rheumatologist 20–22 . The event date is the date on which all criteria are fulfilled.…”

Section: Methodsmentioning

confidence: 99%

Risk of connective tissue disease, morphoea and systemic vasculitis in patients with hidradenitis suppurativa

Schneeweiss

Merola

Schneeweiß

et al. 2020

Acad Dermatol Venereol

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BackgroundHidradenitis suppurativa (HS) has been associated with auto‐inflammatory conditions, yet the risk of developing connective tissue disease (CTD), morphoea and systemic vasculitis has not been well‐characterized.ObjectivesWe sought to evaluate the risk of developing CTD, morphoea and systemic vasculitis in patients with HS.MethodsUsing claims data, we identified patients with HS and used 2 : 1 risk‐set sampling to identify patients without HS. Patients with existing CTD were excluded. Patient follow‐up lasted until first occurrence of the following events: the occurrence of outcome (i.e. systemic lupus erythematosus, morphoea, systemic sclerosis, Sjogren’s Syndrome and systemic vasculitis), death, disenrolment or end of data stream. Hazard ratios (HR) of developing CTD, morphoea and systemic vasculitis were computed after 1 : 1 propensity score (PS) matching.ResultsAfter 2 : 1 risk‐set sampling, we identified 78 122 HS patients and 156 247 non‐HS comparators. The mean follow‐up was 540 days. After PS matching, HS patients had an increased risk of systemic lupus erythematosus HR = 1.63 (1.31–2.03) and morphoea HR = 2.02 (1.32–3.11), compared to non‐HS patients. We did not observe an increased risk for systemic sclerosis HR = 0.90 (0.59–1.44), Sjogren’s Syndrome HR = 0.91 (0.73–1.14) or systemic vasculitis HR = 0.87 (0.64–1.20).ConclusionIn this population‐based study, we observed an increased risk of developing systemic lupus erythematous and morphoea subsequent to a first‐recorded diagnosis of hidradenitis suppurativa.

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“…There are limited and variable data about the economic burden of systemic vasculitis on healthcare systems [ 11 ]. Thorpe et al reported that in the year 2010 in the USA, patients with systemic vasculitis had about double the annual healthcare expenditures compared to their non-vasculitis counterparts [ 12 ]. Babigumira et al reported that the US patients with a new GCA diagnosis had substantially higher health care costs compared to the patients without GCA; the difference in 1-year cost was $16,431 (95% CI $13,821–$19,041) [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

The Delay and Costs of Diagnosing Systemic Vasculitis in a Tertiary-Level Clinic

2020

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Introduction The diagnosis of systemic vasculitis is a challenge because of the heterogeneity of clinical manifestations. The aim of this study is to analyze the diagnostic delay in systemic vasculitis, the total costs during the first year of care, and how the diagnostic delay affects the costs in a tertiary health care facility. Methods Patients with a new diagnosis of systemic vasculitis between 2010 and 2018 were identified from hospital records. The diagnostic delay and health care costs were evaluated during the diagnostic period and within 12 months after the first contact with tertiary health care. Vasculitis-related costs were recorded as true costs charged. A total of 317 patients fulfilled the study criteria. The diagnoses were grouped into three clinically relevant groups: IgA vasculitis and other small-vessel vasculitis ( n = 64), ANCA-associated vasculitis (AAV) ( n = 112), and large-vessel vasculitis (LVV) ( n = 141). Results The diagnostic delay from the first referral to tertiary-level clinic was shortest in the LVV group and longest in the AAV group . Total costs during the diagnostic period were the highest in the AAV group (median = €6754 [IQR €8812]) and lowest in the LVV group (median = €3123 [IQR €4517]), p < 0.001. There was a significant positive correlation between the diagnostic delay and total costs during the diagnostic period and 12 months ( r s = 0.38, p < 0.001 and r s = 0.34, p < 0.001, respectively). In a linear model, the inpatient days and the number of laboratory tests were the strongest predictors ( p < 0.001) of a higher treatment cost during the diagnostic period. Conclusions There is a substantial diagnostic delay that correlates significantly with the costs in tertiary-level health care when diagnosing systemic vasculitis. Electronic supplementary material The online version of this article (10.1007/s40744-020-00266-9) contains supplementary material, which is available to authorized users.

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Healthcare utilization and expenditures for United States Medicare beneficiaries with systemic vasculitis

Abstract: The average Medicare beneficiary with SV incurs about double the annual healthcare expenditures compared to their non-SV counterparts, attributable to increased utilization of almost all categories of care.

Cited by 8 publications

References 24 publications

The HAVEN study—hydroxychloroquine in ANCA vasculitis evaluation—a multicentre, randomised, double-blind, placebo-controlled trial: study protocol and statistical analysis plan

The HAVEN study—hydroxychloroquine in ANCA vasculitis evaluation—a multicentre, randomised, double-blind, placebo-controlled trial: study protocol and statistical analysis plan

Risk of connective tissue disease, morphoea and systemic vasculitis in patients with hidradenitis suppurativa

The Delay and Costs of Diagnosing Systemic Vasculitis in a Tertiary-Level Clinic

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