RESEARCH - The cost of steroid-associated adverse events in RA

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Rheumatology Advance Access originally published online on March 15, 2005

Rheumatology 2005 44(6):781-788; doi:10.1093/rheumatology/keh594

The cost of glucocorticoid-associated adverse events in rheumatoid arthritis

M. Pisu, N. 1, S. Sampsel2 and K. G. Saag2

Center for Outcomes and Effectiveness Research and Education (COERE), 1

School of Nursing and 2 Center for Education and Research on Therapeutics

(CERTs) of Musculoskeletal Disorders, School of Medicine, University of

Alabama at Birmingham, USA.

Objective. To estimate the costs of glucocorticoid associated adverse events

(GAEs) in patients with rheumatoid arthritis (RA).

Methods. We conducted a literature review of studies reporting GAEs in RA

patients, and developed a Markov model with the following GAEs: fractures

(vertebral, hip, pelvic), hypertension, diabetes, gastrointestinal

complications, pneumonia, urinary tract infection, cataract and, in an

extended model, myocardial infarction (MI) and stroke. Two-year total costs

were calculated using direct medical costs (2001 US dollars) and by running

10,000 Monte Carlo simulations with probability values randomly selected

from the GAE literature.

Results. On average, glucocorticoid users spent $445 more than non-users, or

$0.46 for each dollar spent on purchasing the drug. When adding MI and

stroke, users spent on average $430 more than non-users, or $0.44 for each

dollar spent on purchasing the drug; this incremental cost ranged from $193

to $682 if MI and stroke were excluded, respectively. In 70% of the

simulations there were more deaths among users than among non-users, in both

the model with and without MI and stroke.

Conclusions. Although results varied depending on attributed GAEs, in

general glucocorticoid users spent more than non-users on GAE treatment, and

had higher mortality. Patients, providers and policy makers should consider

these potential costs of GAEs when making treatment decisions.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/44/6/781

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