Presumed ocular histoplasmosis syndrome in a commercially insured population, United States

Abstract

To describe epidemiologic features of patients with presumed ocular histoplasmosis syndrome (POHS) in the United States using insurance claims data and compare POHS patients with and without choroidal neovascularization (CNV). Design Retrospective cohort study. Methods Patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for histoplasmosis retinitis on an outpatient claim in the 2014 IBM ® Market-Scan ® Commercial Database and the Medicare Supplemental Database who were enrolled for at least 2 years after the POHS code. Main outcome measures Data related to testing, treatment, and direct medical costs. Results Among >50 million total MarketScan enrollees, 6,678 (13 per 100,000) had a POHS diagnosis code. Of those, 2,718 were enrolled for 2 years; 698 (25%) of whom had a CNV code. Eleven of the 13 states with the highest POHS rates bordered the Mississippi and Ohio rivers. CNV patients had significantly more eye care provider visits (mean 8.8 vs. 3.2, p<0.0001), more ophthalmic imaging tests, higher rates of treatment with anti-vascular endothelial growth factor injections (45% vs. 4%, p<0.0001), and incurred higher mean total yearly costs ($1,251.83 vs. $251.36, p<0.0001) than POHS patients without CNV.

Smoking, Rural Residence and Diabetes as Risk Factors for Presumed Ocular Histoplasmosis Syndrome

“…Our study did not show a significantly higher rate of smoking in patients with POHS with CNV as compared with patients with POHS without CNV, implying that smoking may not significantly increase the risk of developing CNV in patients with POHS. Our findings support those of Benedict et al 11 in a recent epidemiologic study using insurance claim data in which they did not find an association between smoking and CNV in patients with POHS.…”

Revising Conventional Wisdom About Histoplasmosis in the United States

“…Although POHS, a vision-threatening condition, is a well-recognized clinical entity [34,35], the link between histoplasmosis and POHS is often met with skepticism. This condition should not be ignored, as it has been shown to represent ~40% of histoplasmosis codes in insurance claims data, suggesting that it constitutes a substantial part of the health burden of Histoplasma infection (if it truly is the causative agent), potentially affecting hundreds of thousands of people [27]. Notably, the geographic distribution of POHS cases is consistent with the traditional range of Histoplasma.…”

“…Histoplasmosis has long been known to vary widely in terms of severity and organ systems affected, depending on host immune status and inoculum size. The clinical manifestations range from self-limited illness to life-threatening disseminated disease, and complications include pulmonary nodules; erythema nodosum; pericarditis; mediastinal lymphadenitis, granulomas, and fibrosis; and (though controversial) presumed ocular histoplasmosis syndrome [27,28]. This wide range of disease manifestations can make histoplasmosis challenging to recognize.…”

“…Notably, the geographic distribution of POHS cases is consistent with the traditional range of Histoplasma. Further work to understand its etiology and prevalence is needed to help inform early diagnosis and treatment strategies [27].…”

Verteporfin Photodynamic Therapy for the Treatment of Chorioretinal Conditions: A Narrative Review

“…61 Analysis of data from >50 million outpatients in the United States included in the 2014-2016 IBM MarketScan Commercial Database and Medicare Supplemental Database found that 6678 (0.01%) had POHS, with 25% having CNV. 62 Men and women are equally affected. 61 The primary infection is thought to precede symptoms by years.…”