Real-World Health Care Resource Utilization and Costs Among US Patients with Knee Osteoarthritis Compared with Controls.

PURPOSE: To determine the prevalence, healthcare resource utilization and costs (HCRU&C) of knee osteoarthritis (OA) patients versus controls. PATIENTS AND METHODS: Retrospective, matched-cohort administrative claims analysis using IBM MarketScan databases (2011-2017). Newly diagnosed, adult (18+ yrs) knee OA patients identified by ICD9/10 code were matched 1:1 to controls by age, sex, payer, and geography; alpha level set to 0.05. Prevalence was estimated for 2017. All-cause and knee OA-related HCRU&C reported per-patient-per-year (PPPY) over follow-up period up to 4 years. RESULTS: Overall 2017 knee OA prevalence was 4% (615,514 knee OA/15.4M adults). A total of 510,605 patients meeting inclusion criteria were matched 1:1 with controls. The knee OA cohort had mean age 60 years and was 58% female. Versus controls, knee OA patients had significantly more PPPY outpatient (84.5 versus 45.0) and pharmacy (29.8 versus 19.8) claims, and significantly higher PPPY outpatient costs ($12,571 versus $6,465), and pharmacy costs ($3,655 versus $2,038). Knee OA patients incurred $7,707 more PPPY total healthcare costs than controls, of which $4,674 (60.6%) were knee OA-related medical claims and $1,926 (25%) were knee OA-related medications of interest. PPPY costs for nonselective NSAIDs, cyclooxygenase-2 (COX-2) inhibitors, intraarticular hyaluronic acid, non-acute opioids, and knee replacement were higher for knee OA patients than controls. Using median and mean all-cause total cost ($9,330 and $24,550, respectively), the estimated sum cost of knee OA patients in MarketScan ranged from $5.7B to $15B annually. CONCLUSION: This retrospective analysis demonstrated an annual 2017 prevalence of 4.0% (≥18 years) and 13.2% (≥65 years) for newly diagnosed knee OA patients. Compared with controls, all-cause costs were significantly higher for knee OA patients, nearly double that of matched controls, attributable to increased medical and treatment costs and comorbidity treatment burden. Additionally, the estimated annual cost of knee OA treatment was substantial, ranging between $5.7 billion and $15 billion.

Health care resource utilization and burden of disease in a U.S. Medicare population with a principal diagnosis of osteoarthritis of the knee.

AIMS: To assess the prevalence, health care resource utilization (HCRU), and economic burden of disease among Medicare beneficiaries with a principal diagnosis of osteoarthritis (OA) of the knee. MATERIALS AND METHODS: Patients with a principal diagnosis of knee OA were identified from the 5% noninstitutional sample file within 2009 and 2014 Medicare fee-for-service Limited Data Sets. A complete medical benefit record for each individual was generated by linking patient data across corresponding institutional claims from inpatient, outpatient, skilled nursing facility, and home health care services. The study revealed the prevalence and HCRU among Medicare knee OA patients, as well as the patient-level burden of disease by comparing HCRU and costs between knee OA patients and matched control patients. RESULTS: The prevalence of principal diagnosis of knee OA among Medicare beneficiaries increased from 5.9% in 2009 to 6.2% in 2014. Total disease-related claims for the knee OA population was approximately 8 million in 2009 and 9 million in 2014. The average Medicare reimbursement per claim was $12,085 in the inpatient setting, $5,563 in skilled nursing facilities, $2,742 in home health care, $264 in the outpatient setting and $147 in noninstitutional office visits in 2014. Overall, the average total expense per knee OA patient in 2014 was $15,558, an increase of $5,364 compared to the matched control patient. CONCLUSIONS: Many Medicare beneficiaries received care for knee OA, and these patients had significantly greater HCRU than those with the absence of knee OA, totaling over $34 billion in healthcare expenditures in 2014.

Anti-tumor necrosis factor agents reduce corticosteroid use compared with azathioprine in patients with Crohn's disease.

BACKGROUND: Corticosteroids are effective for inducing remission of Crohn's disease, but should not be used long term due to risk of adverse events. Benefits of immunosuppressants (e.g., azathioprine) and anti tumor necrosis factor (anti-TNF) agents include reduced reliance on corticosteroid-based therapies and avoidance of corticosteroid-associated adverse events. Our aim was to evaluate corticosteroid-sparing effects in patients with Crohn's disease upon being newly initiated on an anti-TNFα agent or azathioprine. METHODS: An analysis of US patient claims data from January 2008 to October 2011 was conducted using Truven Health MarketScan Research databases. Corticosteroid-sparing within 12 and 24 months after initiation of an anti-TNF agent (adalimumab, certolizumab pegol, or infliximab) or azathioprine was evaluated. RESULTS: In total, 2900 patients received a prescription for corticosteroids within the 6 month period before the initiation of an anti-TNF agent (63%) or azathioprine (37%). When certolizumab pegol, infliximab, or adalimumab were collectively compared with azathioprine, patients initiated on an anti-TNF agent avoided further prescriptions for corticosteroids at a greater rate than patients receiving azathioprine at 12 (43% vs. 27%, respectively; P < 0.0001) and 24 months (33% vs. 23%, respectively; P = 0.028). Individually, all anti-TNF agents showed higher rates of corticosteroid-sparing compared with azathioprine at 12 (P < 0.0001-0.011), but not 24 months (P = 0.0086-0.24). Key limitations of this study include lack of data regarding disease severity, response and assumptions of improvement, and compliance. CONCLUSIONS: Patients with Crohn's disease were able to avoid new prescriptions for corticosteroids at a statistically higher rate when treated with an anti-TNF agent. These results demonstrate that the anti-TNF agents are superior to azathioprine for minimizing exposure to corticosteroids.