The cost of steroid-associated adverse events in RA

[Guest guest]

Rheumatology (Oxford). 2005 Mar 15; [Epub ahead of print]The cost of glucocorticoid-associated adverse events in rheumatoidarthritis.Pisu M, N, Sampsel S, Saag KG.Center for Outcomes and Effectiveness Research and Education (COERE),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 aliterature review of studies reporting GAEs in RA patients, and developed aMarkov model with the following GAEs: fractures (vertebral, hip, pelvic),hypertension, diabetes, gastrointestinal complications, pneumonia, urinarytract infection, cataract and, in an extended model, myocardial infarction(MI) and stroke. Two-year total costs were calculated using direct medicalcosts (2001 US dollars) and by running 10,000 Monte Carlo simulations withprobability values randomly selected from the GAE literature. Results. Onaverage, glucocorticoid users spent \$445 more than non-users, or \$0.46 foreach dollar spent on purchasing the drug. When adding MI and stroke, usersspent on average \$430 more than non-users, or \$0.44 for each dollar spenton purchasing the drug; this incremental cost ranged from \$193 to \$682 ifMI and stroke were excluded, respectively. In 70% of the simulations therewere more deaths among users than among non-users, in both the model withand without MI and stroke.Conclusions. Although results varied depending on attributed GAEs, ingeneral glucocorticoid users spent more than non-users on GAE treatment, andhad higher mortality. Patients, providers and policy makers should considerthese potential costs of GAEs when making treatment decisions.PMID: 15769791http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstract & list_uids=15769791 & itool=iconabstr