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Ortíz de Frutos J, Carretero G, de Lucas R, Puig S, Serra E, Gómez Castro S, Rebollo Laserna F, Loza E, Silvestre-Salvador JF. Comorbidity Identification and Referral in Atopic Dermatitis: a Consensus Document. J DERMATOL TREAT 2022; 33:2643-2653. [PMID: 35435103 DOI: 10.1080/09546634.2022.2067815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with different comorbidities. OBJECTIVE To develop evidence-based and practical recommendations for comorbidity detection in patients with AD in daily practice. METHODS We employed a modified RAND/UCLA methodology, including a systematic literature review (SLR). A group of six experts on AD was established. We conducted a comprehensive search strategy on Medline, Embase, and Cochrane Library up to June 2020. The selection criteria included studies with AD patients with any comorbidity reporting data on comorbidity prevalence, burden, and management. The included studies quality was assessed. The SLR results were discussed in a nominal group meeting, and several recommendations were generated. The recommendation agreement grade was tested on additional experts through a Delphi process. RESULTS The recommendations cover the following issues: 1) Which comorbidities should be investigated at the first and subsequent visits; 2) How and when should comorbidities be investigated (screening); 3) How should patients with specific comorbidities be referred to confirm their diagnosis and initiate management; 4) Specific recommendations to ensure an integral care approach for AD patients with any comorbidity. CONCLUSIONS These recommendations seek to guide dermatologists, patients, and other stakeholders in regard to early comorbidity identification and AD patient referral to improve decision-making.
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Affiliation(s)
| | - Gregorio Carretero
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Raul de Lucas
- Department of Dermatology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Susana Puig
- Department of Dermatology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Esther Serra
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Juan Francisco Silvestre-Salvador
- Department of Dermatology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-FISABIO Foundation), Alicante, Spain
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2
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Ortsäter G, Geale K, Dun AR, Cappelleri JC, Cha A, Romero W, Henrohn D, Neregard P, Neary MP. Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case-Control Study in Sweden. Dermatol Ther (Heidelb) 2020; 11:161-172. [PMID: 33337521 PMCID: PMC7859158 DOI: 10.1007/s13555-020-00470-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by pruritic, eczematous lesions. Recent evidence suggests that AD may be a systemic disorder, implying that management of this disease extends beyond merely controlling symptoms associated with AD. Even though this disease is highly prevalent in children and patients typically present with mild-to-moderate symptoms, the disease burden is not well established. Methods A large, retrospective cohort study of Swedish population data was conducted to compare the clinical burden in terms of healthcare resource use and direct medical costs for pediatric mild-to-moderate (pM2M) AD patients (≤ 14 years of age, N = 87,721) with matched controls. The burden of a severe AD cohort was also evaluated. Severity of AD was defined by treatment usage and systemic treatment was used as a proxy for severe AD. A robust approach was used by including any type of secondary care visits known to be more common in AD patients than in the general population; however, data for primary care visits were not available. Results For healthcare resource use, the incidence rate ratio (pM2M AD versus reference cohort) of secondary care visits ranged from 1.56 to 2.35 during each of 5 years after AD onset (all p < 0.001), with largest differences seen in years 1–2. The average direct medical cost (SD) was €1111 (3416) and €524 (2446) in the pM2M AD and reference cohorts, respectively. The corresponding estimate in the severe AD cohort was €1906 (7067). Including all secondary care visits and pharmacy-dispensed medications, the pM2M AD cohort was shown to have an additional €118.9 million in direct medical costs over 5 years compared with the reference cohort. Conclusions This study shows significant clinical and economic burden of pM2M AD with important secondary care resource utilization, suggesting a need for further research to increase treatment options and improve the management of these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-020-00470-z.
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Affiliation(s)
| | - Kirk Geale
- Quantify Research AB, Stockholm, Sweden
- Dermatology, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Joseph C Cappelleri
- Global Biometrics and Data Management (Statistics), Pfizer Inc, Groton, CT, USA
| | - Amy Cha
- Inflammation and Immunology, Pfizer Inc, New York, NY, USA
| | | | - Dan Henrohn
- Inflammation and Immunology, Pfizer AB, Stockholm, Sweden
| | - Petra Neregard
- Inflammation and Immunology, Pfizer AB, Stockholm, Sweden
| | - Maureen P Neary
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
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3
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Ophthalmic manifestations of atopic dermatitis. Postepy Dermatol Alergol 2020; 37:174-179. [PMID: 32489350 PMCID: PMC7262807 DOI: 10.5114/ada.2018.79445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022] Open
Abstract
Atopic dermatitis is a chronic condition of complex etiology, whose clinical course involves remission and recurrence. It is not an isolated disease entity affecting only the skin, but one that co-occurs with disorders of other organs. Numerous literature reports have long confirmed the relationship between the disorder and a growing number of ophthalmic manifestations such as keratoconus and retinal detachment. Further studies are required to establish the cause of correlations and to allow for implementation of appropriate prophylaxis and treatment. The aim of the present paper is to review published literature regarding the correlation between atopic dermatitis and ophthalmic manifestations in adults and children.
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4
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Sach T, McManus E, Levell N. Understanding economic evidence for the prevention and treatment of atopic eczema. Br J Dermatol 2019; 181:707-716. [PMID: 30693473 PMCID: PMC6790711 DOI: 10.1111/bjd.17696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atopic eczema is an inflammatory skin condition, with a similar impact on health-related quality of life as other chronic diseases. Increasing pressures on resources within the National Health Service increase the importance of having good economic evidence to inform their allocation. OBJECTIVES To educate dermatologists about economic methods with reference to currently available economic evidence on eczema. METHODS The role of different types of economic evidence is illustrated by evidence found in a systematic literature search conducted across 12 online databases up to 22 May 2017. Primary empirical studies either reporting the results of a cost-of-illness study or evaluating the cost, utility or full economic evaluation of interventions for preventing or treating eczema were included. Two reviewers independently assessed studies for eligibility and performed data abstraction, with disagreements resolved by a third reviewer. Evidence tables of results were produced for narrative discussion. The reporting quality of economic evaluations was assessed. RESULTS Seventy-eight studies (described in 80 papers) were deemed eligible. Thirty-three (42%) were judged to be economic evaluations, 12 (15%) cost analyses, six (8%) utility analyses, 26 (33%) cost-of-illness studies and one a feasibility study (1%). The calcineurin inhibitors tacrolimus and pimecrolimus, as well as barrier creams, had the most economic evidence available. Partially hydrolysed infant formula was the most commonly evaluated prevention. CONCLUSIONS The current level of economic evidence for interventions aimed at preventing and treating eczema is limited compared with that available for clinical outcomes, suggesting that greater collaboration between clinicians and economists might be beneficial.
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Affiliation(s)
- T.H. Sach
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichNR4 7TJU.K.
| | - E. McManus
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichNR4 7TJU.K.
| | - N.J. Levell
- Dermatology DepartmentNorfolk and Norwich University Hospitals NHS Foundation TrustColney LaneNorwichNR4 7UYU.K.
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5
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Launois R, Ezzedine K, Cabout E, Reguai Z, Merrhand S, Heas S, Seneschal J, Misery L, Taieb C. Importance of out-of-pocket costs for adult patients with atopic dermatitis in France. J Eur Acad Dermatol Venereol 2019; 33:1921-1927. [PMID: 30887577 DOI: 10.1111/jdv.15581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Currently, few studies investigated the economic burden of atopic dermatitis (AD) in adult patients and specifically the estimation of out-of-pocket costs. Patients with skin disorders primarily use comfort care to ease dryness, itch or pain, and the costs of comfort care are not subject to any reimbursement from mandatory or complementary insurance. OBJECTIVE The purpose of this study was to measure the medical and non-medical expenses paid by the patient. METHODS Eczema Cohort Longitudinal Adults was a non-interventional study that aimed to assess the burden of AD in terms of quality of life and financial consequences. A self-assessment questionnaire was distributed to adult patients who were cared in four French hospitals. Patients were asked to list the resources consumed for the treatment of AD during the last 12 months and to estimate the corresponding amount of money they had to pay out of their own pockets. The severity of AD was subjected to a stratification based on the PO-SCORAD score. RESULTS A total of 1024 patients answered the questionnaire: 31.9% with severe AD, 40.4% with moderate AD and 27.6% with mild AD. The mean annual out-of-pocket cost was €462.1 for severe AD and €247.4 for moderate AD. Emollients were the most commonly used product: 74.4% for an average out-of-pocket cost of €151.4. The out-of-pocket costs increased significantly with the severity: 27% of patients with severe AD declared having bought specially textured clothes, while 19% of patients with moderate AD reported the same. The corresponding mean out-of-pocket costs were €162 and €91, respectively. CONCLUSION The amount of out-of-pocket costs for patients with AD for essential medical and non-medical expenses is relatively high, compared to the average out-of-pocket cost for French households. Integration of these essential resources into the list of reimbursed products and services appears necessary for a better coverage of AD.
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Affiliation(s)
- R Launois
- Réseau d'Évaluation en Économie de la Santé, REES France, Paris, France
| | - K Ezzedine
- EA EpiDermE, University Paris-Est, Paris, France.,Department of Dermatology, University Hospital Henri Mondor, Créteil, France
| | - E Cabout
- Réseau d'Évaluation en Économie de la Santé, REES France, Paris, France
| | - Z Reguai
- Courlancy Polyclinic, Reims, France
| | - S Merrhand
- Association Française de l'Eczéma, Redon, France
| | - S Heas
- EA4636, University of Rennes 2, Rennes, France
| | - J Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Centre for Rare Skin disorders, University Hospital of Bordeaux, Bordeaux, France
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France.,Laboratory Interactions Neurons-Keratinocytes (LINK), University of Western Brittany, Brest, France
| | - C Taieb
- European Market Maintenance Assessment, Vincennes, France.,Public Health, University Hospital of Necker Enfants Malades, Paris, France
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6
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Gutknecht M, Reinert R, Augustin M. Review of health economic analyses in atopic dermatitis: how diverse is the literature? Expert Rev Pharmacoecon Outcomes Res 2018; 19:127-145. [DOI: 10.1080/14737167.2019.1549491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mandy Gutknecht
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rabea Reinert
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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7
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Siegfried EC, Jaworski JC, Mina-Osorio P. A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns. Dermatol Ther (Heidelb) 2018; 8:349-377. [PMID: 29858763 PMCID: PMC6109028 DOI: 10.1007/s13555-018-0243-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns. METHODS Searches of Embase (2005-2016) and abstracts from selected meetings (2014-2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity. RESULTS Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids. CONCLUSION This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease. FUNDING Regeneron Pharmaceuticals Inc.
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Affiliation(s)
- Elaine C Siegfried
- Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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8
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Increased healthcare utilisation among atopic children in a general practice database: a nested index-control study. BJGP Open 2018; 2:bjgpopen18X101349. [PMID: 30564702 PMCID: PMC6181076 DOI: 10.3399/bjgpopen18x101349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/20/2017] [Indexed: 12/02/2022] Open
Abstract
Background Atopic eczema, asthma, and allergic rhinitis (AR) create a serious burden on general practice resources. Aim To investigate the use of general practice resources (that is, consultation visits, telephone contacts, and home visits) in children with physician-diagnosed atopic disorders (ADs). Design & setting In a nested index-control study design, all children (here defined as individuals aged 2–18 years) listed in a representative general practice database were selected in 2014. Method Children diagnosed with ADs were matched on age and sex with non-atopic controls within the same practice. For all the different groups, the number and frequency of children contacting the GP were calculated. Results Of the children with atopic eczema (n = 15 202), 80% consulted the GP in 2014 (controls = 67%). Of the children with asthma (n = 7754), 80% consulted the GP (controls = 65%), and for children with AR (n = 6710), this was 82% (controls = 66%). Of the children with all three ADs, 91% consulted the GP (controls = 68%). On average, a child with atopic eczema contacted the GP 2.8 times/year (controls = 1.9); for children with asthma, the contact frequency was 3.0 (controls = 1.9); and for AR, 3.2 (controls = 1.9). For children with all three ADs, the contact frequency was 4.3 (controls = 2.0). Consultations related to the ADs investigated only explain a smaller part of the increased healthcare utilisation in atopic children. Conclusion Atopic children use more general practice resources compared to non-atopic children, yet frequently for morbidity or other health-related questions not related to one of the ADs.
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9
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Disease Control, Health Resource Use, Healthcare Costs, and Predictors in Gout Patients in the United States, the United Kingdom, Germany, and France: A Retrospective Analysis. Rheumatol Ther 2016; 3:53-75. [PMID: 27747520 DOI: 10.1007/s40744-016-0033-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The present study aimed to assess disease control, health resource utilization (HRU), and healthcare costs, and their predictors in gout patients across the USA, UK, Germany, and France. METHODS Data were extracted from the PharMetrics Plus (USA), Clinical Practice Research Datalink-Hospital Episode Statistics (UK), and Disease Analyzer databases (Germany and France) for adult gout patients over a 3-year period: 2009-2011 (all dates +1 year for France). Patients had "prevalent established gout" (i.e., were treated with urate-lowering therapy [ULT] or eligible for ULT based on American College of Rheumatology guidelines) in the preindex panel-year, with January 1 of the second study year as the study index date. Assessments of disease control (uncontrolled gout definition: ≥1 serum urate (sUA) elevation or ≥2 flares; analysis limited to the subpopulation with sUA) data, HRU, and costs were in the second post-index panel-year, while potential predictors (demographics and gout treatment characteristics) were identified in the first post-index panel-year. RESULTS Treatment rates were high (>70% with chronic urate-lowering treatment in all countries but France), while between 31.3% (France) and 62.9% (USA) of patients remained uncontrolled. Predictors of control included female gender and high adherence. In Germany, the UK, and France, lack of disease control predicted increased gout-attributed costs and increased HRU, both gout-attributed (also in the USA) and non-gout-attributed. CONCLUSION Gout management remains suboptimal, as many patients remain uncontrolled despite using urate-lowering treatment. Effective and convenient treatment options are needed to improve disease control and minimize additional HRU and costs. FUNDING AstraZeneca.
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10
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Hammer-Helmich L, Linneberg A, Thomsen SF, Tang L, Glümer C. Health service use among children with and without eczema, asthma, and hay fever. Clin Epidemiol 2016; 8:341-349. [PMID: 27695364 PMCID: PMC5028076 DOI: 10.2147/clep.s111960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atopic diseases, for example, eczema, asthma, and hay fever, are among the most common chronic diseases of childhood. Knowledge on health service use among children with atopic disease is limited. This study aimed to investigate the total use and costs of health services for children with and without eczema, asthma, and hay fever in a Danish general population. METHODS We conducted a health survey with four complete birth cohorts from the City of Copenhagen. Individual questionnaire data on eczema, asthma, and hay fever for children aged 3, 6, 11, and 15 years were linked to register information on use and costs of health services and prescribed medication and parental education. In total 9,720 children participated (50.5%). RESULTS We found increased health service use (number of additional consultations per year [95% confidence interval]) among children with current eczema symptoms (1.77 [1.29-2.26]), current asthma symptoms (2.53 [2.08-2.98]), and current hay fever symptoms (1.21 [0.74-1.67]), compared with children without these symptoms. We also found increased use of prescribed medication and most subtypes of health services. Current asthma symptoms and current eczema symptoms, but not current hay fever symptoms, increased the health service costs with at least €300 per year per child. CONCLUSION Children with eczema, asthma, and hay fever used health services and prescribed medication more than children without these diseases.
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Affiliation(s)
- Lene Hammer-Helmich
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen; Department of Real World Evidence and Epidemiology, H. Lundbeck A/S, Valby
| | - Allan Linneberg
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen; Department of Clinical Experimental Research, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Line Tang
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen
| | - Charlotte Glümer
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen; Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Nyberg F, Horne L, Morlock R, Nuevo J, Storgard C, Aiyer L, Hines DM, Ansolabehere X, Chevalier P. Comorbidity Burden in Trial-Aligned Patients with Established Gout in Germany, UK, US, and France: a Retrospective Analysis. Adv Ther 2016; 33:1180-98. [PMID: 27230988 PMCID: PMC4939171 DOI: 10.1007/s12325-016-0346-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 12/22/2022]
Abstract
Introduction Patients with gout have numerous comorbidities. We aimed to estimate the prevalence and incidence rates of renal and cardiovascular morbidities in trial-aligned patients with established gout in Germany (DE), the United Kingdom (UK), the United States (US), and France (FR). Methods This longitudinal cohort study used retrospective data from IMS Disease Analyzer™ (DE, FR), Clinical Practice Research Datalink–Hospital Episode Statistics (UK), and IMS’ PharMetrics Plus database linked with outpatient laboratory results (US). Included patients were ≥18 years at index date (January 1, 2010; all dates +1 year for FR), with continuous enrollment during the pre-index year, had “prevalent established gout” determined by data in the pre-index year, and ≥1 documented visit after index date; additional inclusion/exclusion criteria were aligned with recent gout clinical trials. Look-back for comorbidity prevalence extended to January 1, 2003 (US: January 1, 2009). Follow-up for incidence extended from index date to at most March 26, 2013 (FR: May 31, 2014). Events of interest were identified by diagnostic codes and/or laboratory data. Results The trial-aligned cohorts included 35,118 (DE), 24,607 (UK), 121,591 (US), and 17,338 (FR) patients. Among renal conditions, baseline diagnosis of chronic kidney disease/renal failure was most prevalent in the UK followed by DE; abnormal serum creatinine was most prevalent in the UK. Hypertension was the most prevalent cardiovascular diagnosis in all countries, followed by ischemic heart disease (IHD) and myocardial infarction. Incidence rates (per 100 patient-years) for new/worsening renal impairment ranged from 1.67 (DE) to 4.34 (US) and for nephrolithiasis diagnosis from 0.31 (FR) to 3.79 (US). The incidence rates for hypertension diagnosis were highest among cardiovascular-related events, ranging from 3.23 (UK) to 20.27 (US), followed by IHD. Conclusions Patients with established gout such as those included in gout trials have a high burden of established morbidity and new diagnoses of morbid events. Consideration of comorbidities, which greatly exacerbate disease burden, is important in gout management. Funding AstraZeneca. Electronic supplementary material The online version of this article (doi:10.1007/s12325-016-0346-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fredrik Nyberg
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Mölndal, Sweden.
- Unit of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Laura Horne
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | | | - Javier Nuevo
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
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