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. 2024 Nov 16;24(1):570.
doi: 10.1186/s12890-024-03396-w.

Higher healthcare cost and utilization before and after diagnosis of AATD in the United States

Christopher M Blanchette  1 , Sarah Whitmire  2 , Joshua Oh  1 , Joshua Noone  1 , Reuben Howden  3 , Thomas Ardiles  4 , Glenda A Stone  5
Affiliations

Higher healthcare cost and utilization before and after diagnosis of AATD in the United States

Christopher M Blanchette et al. BMC Pulm Med. .

Abstract

Purpose: Patients with alpha-1 antitrypsin deficiency (AATD) often experience substantial delays from the onset of symptoms to a diagnosis. We explored the impact of delayed diagnosis of AATD on healthcare costs and utilization by assessing costs/utilization before and after diagnosis.

Methods: Retrospective claims data was used to conduct a longitudinal analysis of a cohort of patients with follow-up over four years in a commercial claims database was conducted. Patients with at least four years of claims experience between the years 2011 - 2017 were included in this study. Outcome measures were calculated for each year (Year 1 pre-index diagnosis, and Years 1, 2, and 3 post-index follow-up). Measures included healthcare costs (pharmacy and medical costs), medical costs, inpatient events, and emergency room visits. Unadjusted measures in the follow-up Year 1, Year 2, and Year 3 were compared to Year 1 pre-index. A separate multivariate analysis adjusting for age, sex, and comorbidities was conducted.

Results: Among 1258 patients, mean adjusted healthcare costs were significantly higher in Year 1 post-index compared to Year 1 pre-index ($51,785 vs $41,441, p = < 0.05). In Year 2 ($36,937 vs $41,441, p = < 0.05) and 3 ($28,558 vs $41,441, p = < 0.05) post-index, mean adjusted healthcare costs decreased compared to Year 1 pre-index. Adjusted medical costs were similar in Year 1 ($25,034) post-index compared to Year 1 ($22,952) pre-index but were significantly lower in Year 2 ($15,242 vs $25,034, p = < 0.05) and Year 3 ($8,779 vs $25,034, p = < 0.05) post-index. The frequency of inpatient and emergency room events was significantly lower in all three observation periods following diagnosis in the unadjusted analysis. The adjusted analysis showed similar findings, except for emergency room visits, which were similar across all observation periods.

Conclusion: Patients with AATD had substantial healthcare costs/utilization in the year before diagnosis. Costs were significantly higher in the first year following diagnosis. However, subsequent years showed cost reductions to levels below pre-diagnosis. These data support the need for strategies to reduce the time from symptom onset to diagnosis.

Keywords: Alpha-1 antitrypsin deficiency; COPD; Healthcare costs; PiZZ.

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Conflict of interest statement

Declarations Ethics approval and consent to participate Higher healthcare cost and utilization before and after diagnosis of AATD in the United States, is a retrospective claims analysis. A Clinical Trial Number is therefore not applicable in this case. The source data for this analysis was the PharMetrics™ Plus Commercial Database. This database utilizes de-identified, HIPAA compliant data. The use of de-identified, publicly available data does not constitute human subjects research as defined at 45 CFR 46.102. Therefore, this study was exempt from review by an institutional review board/ethics committee. Consent for publications All data reported are in the aggregate and impossible to link to individual participants, so individual informed consent was not required. Competing interests Drs. Blanchette, Howden, Oh, Noone, and Ms. Whitmire have each received consultation fees from Grifols, Inc. in the past. Dr. Ardiles is an employee of Grifols Shared Services of North America, a subsidiary of Grifols, Inc. Dr. Stone was an employee of Grifols Inc., at the time the research was conducted. Grifols, Inc. a manufacturer of a marketed therapy for the treatment of AATD, funded this study and preparation of this manuscript.

Figures

Fig. 1
Fig. 1
Mean unadjusted healthcare cost among patients with alpha-1 antitrypsin deficiency
Fig. 2
Fig. 2
Mean adjusted healthcare cost among patients with alpha-1 antitrypsin deficiency
See this image and copyright information in PMC

References

    1. Cortes-Lopez R, Barjaktarevic I. Alpha-1 Antitrypsin Deficiency: A Rare Disease? Current Allergy Asthma Rep. 2020;20:51. 10.1007/s11882-020-00942-4. - PubMed
    1. Brantly ML. Efficient and accurate approaches to the laboratory diagnosis of α1-antitrypsin deficiency: the promise of early diagnosis and intervention. Clin Chem. 2006;52:2180–1. - PubMed
    1. Crystal RG. α1-antitrypsin deficiency, emphysema, and liver disease: genetic basis and strategies for therapy. J Clin Invest. 1990;85:1343–52. - PMC - PubMed
    1. Stoller JK, Hupertz V, Aboussouan LS. Alpha-1 Antitrypsin Deficiency. 2006 Oct 27 [Updated 2023 Jun 1]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews®. Seattle (WA): University of Washington, Seattle; 1993–2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1519/.
    1. Barjaktarevic I, Campos M. Management of lung disease in alpha-1 antitrypsin deficiency: what we do and what we do not know. Ther Adv Chronic Dis. 2021 Jul 29;12_suppl:20406223211010172. 10.1177/20406223211010172. PMID: 34408831; PMCID: PMC8367208. - PMC - PubMed

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