Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2015) 37 GP01.02 | DOI: 10.1530/endoabs.37.GP.01.02

ECE2015 Guided Posters Adrenal (8 abstracts)

Defining and exploring the excessive healthcare burden of adrenal insufficiency

Paul Stewart 1 , Beverly M K Biller 2 , Claudio Marelli 3 , Candace Gunnarsson 4 , Michael Ryan 4 & Gudmundur Johannsson 5

1University of Leeds, Leeds, UK; 2Massachusetts General Hospital, Boston, Massachusetts, USA; 3Shire, Zug, Switzerland; 4CTI Clinical Trial and Consulting, Cincinnati, Ohio, USA; 5Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.

Introduction: The clinical outcome of patients with adrenal insufficiency (AI) has been shown to be less favorable than previously thought. Clinical studies have shown increased mortality, reduced cardiovascular and skeletal health and compromised quality of life, but the impact of this upon healthcare burden is unknown. This research utilised real-world evidence to compare comorbidities, healthcare utilization and expenditures in patients with AI.

Methods/design: Administrative health claims data from Truven Health MarketScan Commercial and Medicare databases (January 2006–June 2011) were used. Inclusion criteria were at least two diagnosis codes for AI and a minimum of 1 year of continuous health and pharmacy coverage following diagnosis. Patients were classified into cohorts of secondary AI (SAI) due to pituitary disorder (n=1529), primary AI (PAI) (n=705), and congenital adrenal hyperplasia (CAH) (n=242). Patients were matched 1:1 on age, gender, insurance type, and region to a general control population. Unadjusted average healthcare utilization and expenditures over 12 months are reported for each cohort and control. Multivariable models will be generated to estimate healthcare utilization and expenditures.

Results: All three groups showed higher relative risk of anxiety (SAI 1.87 (CI: 1.60, 2.18)); (PAI 1.89 (1.52, 2.35)); (CAH 2.14 (1.17, 3.94)); hypertension (SAI 1.25 (1.16, 1.35)); (PAI 1.15 (1.01, 1.32)); (CAH 1.60 (1.09, 2.35)); and diabetes mellitus (SAI 1.52 (1.31, 1.76)); (PAI 1.60 (1.24, 2.05)); (CAH 2.83 (1.50, 5.34)) than the general population. Depression (SAI 1.55 (1.39, 1.74)); (PAI 1.44 (1.23, 1.67)); and hyperlipidemia (SAI 1.36 (1.26, 1.47)); (PAI 1.23 (1.08, 1.41)); were higher in the SAI and PAI cohorts. Inpatient hospitalizations with infection were a frequent primary diagnosis for all three cohorts. Average total 12-month expenditures for each cohort compared to their matched controls were as follows: SAI=$29 628/control=$7044, PAI=$19 795/control=$5480, and CAH=$6145/control=$3542.

Conclusions: Patients with AI carry a significant healthcare burden with higher risk of comorbidities, hospital admissions and healthcare expenditures compared to the general population.

Disclosure: This work was funded by Shire International GmbH.

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