Impact of systemic corticosteroids on healthcare utilization in patients with sarcoidosis

Abstract

Introduction: Practical complications of chronic systemic corticosteroid (SC) use in patients with sarcoidosis are poorly characterized. The objective of this study was to determine the impact of SC use in patients with sarcoidosis on unscheduled sarcoidosis-attributed and nonsarcoidosis-attributed healthcare utilization (SHCU and NSHCU, respectively).

Methods: Retrospective analysis of patient-reported HCU between clinic visits at a university hospital sarcoidosis outpatient clinic.

Results: A total of 441 included patients had a mean (standard deviation) of 2.4 (1.2) organs involved, were followed up for a mean of 2.9 (2.4) years and received a median cumulative dose of 2680 mg of prednisone. Patients in the higher 50th percentile of cumulated SC reported a higher unadjusted mean annual SHCU (0.33 versus 0.22, P < 0.0001 by Wilcoxon rank-sum test) but a similar mean annual NSHCU (0.83 versus 1.00, P = .88). After adjustment for age, race and sex, persons in the higher 50th percentile of corticosteroid exposure had a similar odds of overall NSHCU (adjusted odds ratio = 1.03, 95% CI = 0.74–1.44) but a 2.2 (95% CI = 1.5–3.3) odds of greater nonsarcoidosis attributable emergency department visits. In separate analysis of the reasons for NSHCU, persons with greater SC use had a 1.74 (95% CI = 1.16–2.62) odds of more infectious disease-related complaints and a trend toward more visits for cardiovascular problems (OR = 1.49, 95% CI = 0.96–2.32).

Conclusions: Greater SC use is associated with small but significant increase in HCU related to infection and increased unscheduled emergency department visits for complaints not directly attributable to sarcoidosis.