|
Radmila Choate, MPH1 David M. Mannino, MD1 Kristen E. Holm, PhD, MPH2 Robert A. Sandhaus, MD, PhD3
Author Affiliations
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington
- Division of Medical, Behavioral, and Community Health, National Jewish Health; Department of Community and Behavioral Health, University of Colorado Denver School of Public Health, Denver
- Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver
Address correspondence to:
Radmila Choate, MPH
Department of Preventive Medicine and Environmental Health
University of Kentucky College of Public Health
111 Washington Avenue
Lexington, KY 40536
Phone: 859-218-2237
E-mail: radmila.choate@uky.edu
Abstract
Background: The aim of this study was to examine differences in demographic, health, and behavioral characteristics in individuals with ZZ and SZ genotypes of alpha-1 antitrypsin deficiency (AATD) within AlphaNet’s Disease Management and Prevention Program (ADMAPP).
Methods: Self-reported data from 3535 patients with AATD, including 3031 (85.7%) patients with ZZ, ZNull, and NullNull genotypes (referred to here as ZZ), and 504 (14.3%) with the SZ genotype were analyzed using t-tests, ANOVAs, and Chi-squared tests.
Results: The average age of the cohort was 56.3±10.6 years. The majority of respondents were male (51.2%), white (98.2%) and married (65.2%). SZs reported having more frequent exacerbations (p<0.001) and hospitalizations (p=0.012) than ZZs. A higher proportion of SZs than ZZs had been diagnosed with high blood pressure, diabetes, congestive heart failure, and other comorbid conditions. SZs were more likely than ZZs to report “poor” health (p=0.005). Over a third (38.4%) of SZs do not exercise compared to 27.1% of ZZs (p<0.001). A greater proportion of SZs compared to ZZs view themselves as being overweight (p<0.001) or “out of shape” (p=0.001). A higher proportion of SZs than ZZs reported any history of smoking and current smoking (p<0.001).
Conclusions: In patients with AATD and lung disease participating in a disease management program, a higher proportion of SZs than ZZs report exacerbations, comorbidities, and overall poor health, as well as unhealthy behaviors such as lack of exercise and current smoking. Future work should consider the extent to which genotype-specific health promotion interventions would be useful.
Citation
Citation: Choate R, Mannino DM, Holm KE, Sandhaus R. Comparing patients with ZZ versus SZ alpha-1 antitrypsin deficiency: findings from AlphaNet’s disease management program. Chronic Obstr Pulm Dis. 2019; 6(1):In press. doi: http://dx.doi.org/10.15326/jcopdf.6.1.2018.0134
|
Jan Sieluk, MPharm, PhD1,2 Joseph Levy, PhD1 Robert A. Sandhaus, MD, PhD3 Henry Silverman, MD, PhD4 Kristen E. Holm, PhD5 C. Daniel Mullins, PhD1
Author Affiliations
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore
- OptumLabs, Cambridge, Massachusetts
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
- School of Medicine, University of Maryland, Baltimore
- Division of Medical, Behavioral, and Community Health, National Jewish Health, Denver, Colorado
Address correspondence to:
C. Daniel Mullins, PhD
Pharmaceutical Health Services Research Department
University of Maryland School of Pharmacy
220 N Arch St, 12th Floor
Baltimore, MD 21201-1531 Email: Daniel.Mullins@rx.umaryland.edu
Abstract
Background: This study is the first to utilize a large claims database to estimate medical costs of patients with alpha-1 antitrypsin deficiency (AATD) in the United States.
Methods: Adult AATD patients were identified from the OptumLabs™ Data Warehouse. Insurer and patient out-of-pocket costs were categorized into the following cost buckets, stratified by augmentation therapy use: physician visits (PV), emergency department visits (ED), inpatient stays (IP), augmentation therapy (AUG), other prescription drug costs (RX), and other costs (OTH). Costs were weighted and adjusted to 2017 U.S. dollars using the medical care component of the consumer price index.
Results: The study cohort consisted of9117 AATD patients followed for 53,872 person years observed between 1993 and 2015. The annual costs among AATD patients totaled $127,537 among augmentation therapy users and $15,874 among non-users. The major drivers of annual costs to the insurer among the 7975 patients not on augmentation therapy were: PV: $5352 (37.7%) and IP: $4506 (31.8%). Among the 1142 augmentation users, major annual cost drivers to the insurer were PV: $15,064 (12.3%) and AUG: $82,002 (66.7%). Annual patient out-of-pocket costs were $4601 (AUG: $2084 [45.3%]; RX: $940 [20.4%]) and $1689 (PV: $727 [43.0%]; RX: $589 [34.9%]) among augmentation therapy users and non-users, respectively. Averaged across the entire cohort, the average annual costs per AATD patient were $22,975, paid by insurers ($21,100) and patients ($1875).
Conclusions: Annual medical costs among patients with AATD are $127,537 and $15,874 among augmentation therapy users and non-users, respectively, with 75.3% of the cost difference attributable to AUG.
Citation
Citation: Sieluk J, Levy J, Sandhaus RA, Silverman H, Holm KE, Mullins CD. Costs of medical care among augmentation therapy uses and non-users with alpha-1 antitrypsin deficiency in the United States. Chronic Obstr Pulm Dis. 2019; 6(1):In press. doi: http://dx.doi.org/10.15326/jcopdf.6.1.2017.0187
|
|