Janssen (Hungary)

ObjectivesThe aim of this national population-based, retrospective database study is to compare the comorbidity profiles of systemic lupus erythematosus (SLE) patients and general population controls matched for age, gender, and region and assess the risk of depression or anxiety when controlled for age, gender and adjusted for the Charlson Comorbidity Index (CCI).MethodsClaims data of 1051 patients diagnosed with SLE (full population between January 01, 2011, and December 31, 2014) from the Hungarian National Health Insurance Fund have been analyzed against matched controls (1:5 ratio) with a follow-up of 30 months. The first record of SLE diagnosis was considered the diagnosis date. The odds ratio (OR) and 99.9% confidence interval (CI) of having depression or anxiety among patients with SLE vs. controls have been assessed using logistic regression models.ResultsSLE patients report more comorbidities than the matched general population both in pre- and post-index periods (mean CCI 1.79 vs. 1.15 and 2.78 vs. 1.22 [both p<0.001], respectively). Both SLE patients and controls diagnosed with depression or anxiety had significantly higher CCI than those without comorbid depression or anxiety (p<0.001). However, SLE patients had a twofold higher risk of depression or anxiety than matched controls when controlled for age, gender, and adjusted for CCI.ConclusionOur analysis indicates the enormity of comorbidity burden in SLE, especially that of anxiety and depression. The size and complexity of the comorbidity burden emphasizes the importance of early diagnosis and intervention with comprehensive modalities incorporating attention to comorbidities in SLE patients.

Use claims data to assess healthcare resource utilization (HCRU) and cost for patients with ulcerative colitis (UC) who had surgery and patients who did not. UC patients from a German health insurance were included between 01/01/2010-31/12/2017. Patients with proctocolectomy or colectomy between 01/07/2010 and 31/12/2014 were identified, and surgery date was set as index. For patients with IPAA, the last surgery in the 6 months was taken as index. Non-surgery patients received random index. After propensity score matching, UC-related HCRU and cost were observed for three years post-index. Of 21,392 UC patients, 85 underwent surgery and 2655 did not. After matching, 76 were included in the surgery group and 114 in the non-surgery group. Matched cohorts did not differ in baseline characteristics and mortality rates where high in both groups (21.1% and 29.0%, respectively). The percentage of patients with at least one hospitalization in the follow-up period was higher in the surgery (53.9%) compared to the non-surgery group (25.4%, p<0.001). In contrast, the number of outpatient prescriptions of UC-related drugs in the non-surgery group (11.2) was almost twice as large as in the surgery group (5.8, p<0.001). Hospitalization cost was 4.6 times higher in the surgery (1955.5€) than in the non-surgery group (419.6€, p<0.001). Medication cost was three times higher in the non-surgery group (6519€) compared to the surgery group (2151.7€, p<0.001). Based on hospitalizations, outpatient visits, and medical treatment, results show a considerable patient burden in UC from surgery complications or disease exacerbation in case of colectomy.

INTRODUCTION: Proctocolectomy in patients with ulcerative colitis (UC) is traditionally considered curative. However, little is known on the long-term complications and costs of surgery in UC and previous literature mostly relied on hospital registry data. Using German claims data, this study explored long-term healthcare resource utilization (HCRU) and costs among UC patients who had surgery and patients who did not. METHODS: Patients from a German health insurance with a UC diagnosis between 01/01/2010-31/12/2017 were included. Patients who had proctocolectomy or colectomy after first UC diagnosis and between 01/07/2010-31/12/2014 were identified and surgery date was set as index. Non-surgery patients were given a random index date in the inclusion period after first UC diagnosis, and were required to have received a corticosteroid or biologic in the six months before index. A 1:2 nearest-neighbor propensity score matching (PSM) with replacement was used and UC-related hospital stays and costs, as well as outpatient visits, were studied in the three years after index. RESULTS: Of 21,392 UC patients, 76 were included in the surgery group (34 proctocolectomy, 37 colectomy, 5 other) and 114 in the non-surgery group. Matched cohorts did not differ significantly in the baseline characteristics and mortality rates where high in both groups (21.1% and 29.0%, respectively). Patients who had surgery relied less on biologics compared to patients who did not (10.5% vs 23.7%, P = 0.022), but the number of UC-related hospitalizations per-patient-year (PPY) was twice as large in the surgery group than in the non-surgery group (0.4 vs 0.2, P &lt; 0.001), and no significant difference in the number of UC-related outpatient visits PPY was observed (7.2 vs 7.0, P = 0.364). This resulted in higher UC-related hospitalization costs for patients who had surgery (cost-ratio = 4.3, 95% CI: 2.0, 6.7). Costs of UC-related medications were lower for patients who had surgery (cost-ratio = 0.2, 95% CI: 0.0, 0.4), but they increased over the follow-up period for patients in the surgery group and approached costs in the non-surgery group. CONCLUSION: While PSM does not account for unobservable confounders and further research on patients who had proctocolectomy is required, this work is the first to study long-term HCRU and costs among UC patients who had surgery and patients who did not, based on claims data. Results show that surgical options may be not curative and result in high hospitalization costs.