Comorbidity burden and health resource utilization in controlled vs. uncontrolled gout: A retrospective claims-based analysis
Richard Lai (1), Suneet Grewal (2), Kaiding Zhu (3), Stephani Gray (3), Andrea Meyers (3), Brian Lamoreaux (3)
Affiliation(s):
1.Montana Arthritis Center, Great Falls, United States of America,
2. East Bay Rheumatology Medical Group, Inc., San Leandro, USA, 3Amgen, Inc., Thousand Oaks, USA
Introduction: Compared to patients (pts} without gout, pts with gout have higher comorbidity,1 health resource utilization (HRU),2 and mortality (cardiovascular3 and all-cause4). Quality of life is also impacted, particularly by pain and gout flare.5 A prior study showed higher comorbidity burden in pts with uncontrolled vs. controlled gout, including increased CKD and cardiovascular disease (CVD) prevalence.6 Here, we further explore comorbidities and HRU in pts with uncontrolled vs. controlled gout.
Methods: Closed-claims data were examined (2015-2023; Merative™ MarketScan® Research Databases, commercially insured [primary and secondary plans]). Date of gout diagnosis confirmation was set as index (Figure 1). Inclusion criteria were ≥18 years at index and a gout diagnosis code (ICD-10 M10.*) during the baseline period (1 year prior to index}. Controlled pts had no gout symptoms (tophi, flare, gout-related ED/hospital visit} during baseline and last pre-index serum urate (SU) <6 mg/dl. Uncontrolled pts had gout symptoms during baseline, elevated SU (last pre-index ≥8 mg/dl or pre-index ≥6 mg/dl for ≥3 months), and ≥360 days oral ULT use. CVD was identified as any Disease of the Circulatory System (100-199, included hypertension); CKD as unspecified/staged CKD (N18.*); gout-related pain as joint pain (M25.5*) or joint aspiration (20600, 4-6, 10, 11 ). Gout-related HRU encounters had an associated gout code (in any position).
Results: 2435 uncontrolled (83% men, age: 56.8±13.4 years, baseline SU: 8.5±1.7 mg/dl) and 2697 controlled (81% men, age: 60.5±12.5 yrs, baseline SU: 5.1±1.2 mg/dl) pts were included. Stage 3-5 CKD (28% vs 18%), cardiac event (11% vs 6%), ischemic heart disease (IHD; 21% vs 15%), and VTE (4% vs 2%) had significantly higher prevalence during baseline despite younger age in uncontrolled gout pts (all p< 0.001). Uncontrolled pts also had higher rates of gout-related pain (48% vs 23%) and anxiety (9% vs. 7%; both p< 0.001). After gout diagnosis confirmation, incidence of nonfatal stroke, IHD, and heart failure was significantly higher in uncontrolled vs. controlled pts (both in database 2.8±1.5 yrs after index, all p< 0.001). Uncontrolled gout pts also had more CKD development/worsening (based on highest CKD stage) and higher HRU, including all-cause and gout-related hospitalization, ED visits, and urgent care visits.
Conclusion: Though causality cannot be established, these findings strongly suggest higher disease burden and progression in pts with uncontrolled vs. controlled gout. Of note, differences from controlled gout pts were noted within the first few years after gout diagnosis with uncontrolled gout pts having higher incidence of stroke, ICD, and heart failure, more CKD development/ progression, and higher HRU.
References:
1. Kuo CF, et al. Ann Rheum Dis 2016;75:210-7
2. Trieste L, et al. Clin Exp Rheumatol 2012;30:S145-8
3. Kuo CF, et al. Rheumatology2010;49:141-6
4. Vincent ZL, et al.) Rheumato/2017;44:368-73
5. Watson L, et al. Rheumatology2023;62:2748-56
6. Francis-Sedlak M, et al. Rheumatol Ther2021 ;8:183-97
Disclosure of interest: Richard HC Lai Abbvie, Amgen, Glaxo Smith Kline, Horizon (now Amgen, Inc.), Mallinckrodt, and Pfizer, Suneet Grewal Glaxo Smith Kline, Horizon (now Amgen, Inc.), and UCB, Horizon (now Amgen, Inc.), Kaiding Zhu Amgen, Inc., Amgen, Inc., Stephani Gray Amgen, Inc., Andrea Meyers Amgen, Inc., Amgen, Inc., Brian LaMoreaux Amgen, Inc., Amgen, Inc.
