Disease-Related and All-Cause Health Care Costs of Elderly Patients With Gout

• DOI: 10.18553/jmcp.2008.14.2.164
• Publication Date: 2016-02-21T09:29:37Z
• Authors: Eric Q. Wu; Pankaj A. Patel; Andrew P. Yu; Reema R. Mody; Kevin E. Cahill; Jackson Tang; Eswar Krishnan
• Keywords: Febuxostat; Sulfinpyrazone; Allopurinol; Probenecid; Diagnosis code

Gout is a common cause of inflammatory arthritis in the United States, and its prevalence has increased recent decades, especially among older adults. Older adults with gout are particular interest because they tend to experience higher rates tophi, an advanced stage gout, than do younger patients.For (1) assess health care utilization costs from third-party payer perspective; (2) evaluate related tophi; (3) explore relationship between elevated serum uric acid (UA) level, indicator disease control, utilization.Data were extracted Integrated Healthcare Information Services (IHCIS) claims database (1999-2005), which includes approximately 40 private plans States for 13 million beneficiaries, about 4% whom aged 65 years or older. Patients included study if they: had 2 diagnoses (International Classification Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 274.xx) on separate medical 1 diagnosis plus at least gout-related pharmacy claim (i.e., allopurinol, probenecid, colchicines, sulfinpyrazone); old first date (study index date); year continuous eligibility both before after date. A comparison sample elderly members without was selected using 1:1 match patients based age, gender, geographic region. Individuals group also date, defined as same respective matched patient. possible tophi identified ICD-9-CM 274.8x (274.81=gouty ear; 274.82 = gouty other sites except 274.89 specified manifestations) during 12-month period following Additionally, subgroup UA measure selected. divided into 3 groups according their level earliest test (serum date): low (< 6 mg per dL), moderate-high (6-8.99 very high (> 9 dL). Health categorized inpatient services, outpatient emergency room use prescription drugs. Medical services classified by place service indicated claim. amount paid provider member cost share (e.g., deductible, copayment). Two types assessed analysis: total all-cause costs, associated primary secondary (ICD-9-CM 274.xx). Differences calculated comparing gout-free date; across categories Multivariate regression analyses used control patients' baseline demographics, prior comorbidities Deyo-Charlson Comorbidity Index, number medications 12 months date.Over 7 data through 2005, there 11,935 The average age 71.4 predominantly male (73.5%). In mean unadjusted per-patient $876 (standard deviation $3,373) 2005 dollars, 5.9% $14,734 (SD $27,401) patients. Unadjusted $9,219 $20,186). After statistical adjustment comorbidities, difference $3,038 (P < 0.001). suggesting found 2.0% (n 240) sample. $5,501 0.001), adjusted $1,710 Among 2,237 (18.7%) measure, 28.3% 52.4% 19.3% level. For low, moderate-high, levels, regression-adjusted represented, respectively, 2.9%, 2.7%, 3.9% costs. significantly compared those ($3,103 $276 higher, respectively).Elderly have gout. Gout-related represent 6% Very levels > dL)