To the Editor:
We thank Dr. Mullins1 for his comments on our recent article2 on the trends in emergency department (ED) visits and charges for gout in the United States between 2006 and 2012. In our paper, we showed that the number of gout ED visits and cost significantly rose over the years.
Concerning the comment of Dr. Mullins on the possibility of the colchicine policy change affecting sharp increase of ED visits since 2009, it is beyond the data available in the Nationwide Emergency Department Sample (NEDS). We stated in the Discussion section that we could not perform patient-level analyses such as colchicine prescription across different insurance types because NEDS does not contain these data.
However, we acknowledge this as an important point. Recently, Kesselheim, et al3 showed a reduction in colchicine initiation and an increase in patient spending among patients with gout in United Health–affiliated enrollees after January 2011 when the market exclusively enforced colchicine patency. Along with our data, it is speculated that the reduction in colchicine use may have contributed to unnecessary office or hospital visits by patients because of suboptimal care. Further followup studies may be warranted to see whether healthcare use by patients with gout changes with expected improvement of patient access to affordable colchicine in coming years4.