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Research ArticleArticle

Association Between Glucocorticoid Exposure and Healthcare Expenditures for Potential Glucocorticoid-related Adverse Events in Patients with Rheumatoid Arthritis

Jennie H. Best, Amanda M. Kong, Gregory M. Lenhart, Khaled Sarsour, Marni Stott-Miller and Yong Hwang
The Journal of Rheumatology January 2018, jrheum.170418; DOI: https://doi.org/10.3899/jrheum.170418
Jennie H. Best
From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA. This analysis was funded by Genentech Inc. Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted. J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh. Address correspondence to A.M. Kong, 75 Binney St., Cambridge, Massachusetts 02142, USA. E-mail: akong@us.ibm.com. Accepted for publication September 15, 2017.
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Amanda M. Kong
From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA. This analysis was funded by Genentech Inc. Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted. J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh. Address correspondence to A.M. Kong, 75 Binney St., Cambridge, Massachusetts 02142, USA. E-mail: akong@us.ibm.com. Accepted for publication September 15, 2017.
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Gregory M. Lenhart
From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA. This analysis was funded by Genentech Inc. Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted. J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh. Address correspondence to A.M. Kong, 75 Binney St., Cambridge, Massachusetts 02142, USA. E-mail: akong@us.ibm.com. Accepted for publication September 15, 2017.
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Khaled Sarsour
From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA. This analysis was funded by Genentech Inc. Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted. J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh. Address correspondence to A.M. Kong, 75 Binney St., Cambridge, Massachusetts 02142, USA. E-mail: akong@us.ibm.com. Accepted for publication September 15, 2017.
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Marni Stott-Miller
From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA. This analysis was funded by Genentech Inc. Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted. J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh. Address correspondence to A.M. Kong, 75 Binney St., Cambridge, Massachusetts 02142, USA. E-mail: akong@us.ibm.com. Accepted for publication September 15, 2017.
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Yong Hwang
From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA. This analysis was funded by Genentech Inc. Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted. J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh. Address correspondence to A.M. Kong, 75 Binney St., Cambridge, Massachusetts 02142, USA. E-mail: akong@us.ibm.com. Accepted for publication September 15, 2017.
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Abstract

Objective Oral glucocorticoid (OGC) use for rheumatoid arthritis (RA) is debated because of the adverse event (AE) profile of OGC. We evaluated the associations between cumulative doses of OGC and potential OGC-related AE, and quantified the associated healthcare expenditures.

Methods Using the MarketScan databases, patients ≥ 18 years old who have RA with continuous enrollment from January 1 to December 31, 2012 (baseline), and from January 1 to December 31, 2013 (evaluation period), were identified. Cumulative OGC dose was measured using prescription claims during the baseline period. Potential OGC-related AE (osteoporosis, fracture, aseptic necrosis of the bone, type 2 diabetes, ulcer/gastrointestinal bleeding, cataract, hospitalization for opportunistic infection, myocardial infarction, or stroke) and AE-related expenditures (2013 US$) were gathered during the evaluation period. Multivariable regression models were fitted to estimate OR of AE and incremental costs for patients with AE.

Results There were 84,357 patients analyzed, of whom 48% used OGC during the baseline period and 26% had an AE during the evaluation period. A cumulative OGC dose > 1800 mg was associated with an increased risk of any AE compared with no OGC exposure (OR 1.19, 99.65% CI 1.09–1.30). Incremental costs per patient with any AE were significantly greater for cumulative OGC dose > 1800 mg compared with no OGC exposure (incremental cost = $3528, 99.65% CI $2402–$4793).

Conclusion Chronic exposure to low to medium doses of OGC was associated with significantly increased risk of potential OGC-related AE in patients with RA, and greater cumulative OGC dose was associated with substantially higher AE-related healthcare expenditures among patients with AE.

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The Journal of Rheumatology: 46 (2)
The Journal of Rheumatology
Vol. 46, Issue 2
1 Feb 2019
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Association Between Glucocorticoid Exposure and Healthcare Expenditures for Potential Glucocorticoid-related Adverse Events in Patients with Rheumatoid Arthritis
Jennie H. Best, Amanda M. Kong, Gregory M. Lenhart, Khaled Sarsour, Marni Stott-Miller, Yong Hwang
The Journal of Rheumatology Jan 2018, jrheum.170418; DOI: 10.3899/jrheum.170418

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Association Between Glucocorticoid Exposure and Healthcare Expenditures for Potential Glucocorticoid-related Adverse Events in Patients with Rheumatoid Arthritis
Jennie H. Best, Amanda M. Kong, Gregory M. Lenhart, Khaled Sarsour, Marni Stott-Miller, Yong Hwang
The Journal of Rheumatology Jan 2018, jrheum.170418; DOI: 10.3899/jrheum.170418
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