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Uwitonze JP, Duminy L, Blankart CR. Identifying health inequities faced by older adults with rare diseases: A systematic literature review and proposal for an ethical spectrum and resource allocation framework. Health Policy 2024; 149:105176. [PMID: 39348734 DOI: 10.1016/j.healthpol.2024.105176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 09/16/2024] [Accepted: 09/25/2024] [Indexed: 10/02/2024]
Abstract
Ageism in healthcare has received increased attention in recent years, but literature focusing on how it affects individuals living with rare diseases remains scant. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or that discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an Ethical Spectrum and Resource Allocation Framework, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients.
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Affiliation(s)
- Jean Pierre Uwitonze
- KPM Center for Public Management, University of Bern, Freiburgstr. 3, 3010 Bern, Switzerland; Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel, Freiburgstr. 3, 3010 Bern, Switzerland; Center for Health System Sustainability, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Lize Duminy
- KPM Center for Public Management, University of Bern, Freiburgstr. 3, 3010 Bern, Switzerland; Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel, Freiburgstr. 3, 3010 Bern, Switzerland
| | - Carl Rudolf Blankart
- KPM Center for Public Management, University of Bern, Freiburgstr. 3, 3010 Bern, Switzerland; Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel, Freiburgstr. 3, 3010 Bern, Switzerland
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Wang CM, Whiting AH, Rath A, Anido R, Ardigò D, Baynam G, Dawkins H, Hamosh A, Le Cam Y, Malherbe H, Molster CM, Monaco L, Padilla CD, Pariser AR, Robinson PN, Rodwell C, Schaefer F, Weber S, Macchia F. Operational description of rare diseases: a reference to improve the recognition and visibility of rare diseases. Orphanet J Rare Dis 2024; 19:334. [PMID: 39261914 PMCID: PMC11389069 DOI: 10.1186/s13023-024-03322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/08/2024] [Indexed: 09/13/2024] Open
Abstract
Improving health and social equity for persons living with a rare disease (PLWRD) is increasingly recognized as a global policy priority. However, there is currently no international alignment on how to define and describe rare diseases. A global reference is needed to establish a mutual understanding to inform a wide range of stakeholders for actions. A multi-stakeholder, global panel of rare disease experts, came together and developed an Operational Description of Rare Diseases. This reference describes which diseases are considered rare, how many persons are affected and why the rare disease population demands specific attention. The operational description of rare diseases is framed in two parts: a core definition of rare diseases, complemented by a descriptive framework of rare diseases. The core definition includes parameters that permit the identification of which diseases are considered rare, and how many persons are affected. The descriptive framework elaborates on the impact and burden of rare diseases on patients, their caregivers and families, healthcare systems, and society overall. The Operational Description of Rare Diseases establishes a common point of reference for decision-makers across the world who strive to understand and address the unmet needs of persons living with a rare disease. Adoption of this reference is essential to improving the visibility of rare conditions in health systems across the world. Greater recognition of the burden of rare diseases will motivate new actions and policies to address the unmet needs of the rare disease community.
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Affiliation(s)
- Chiuhui Mary Wang
- Rare Diseases International, Plateforme Maladies Rares, 96 rue Didot, Paris, 75014, France.
| | - Amy Heagle Whiting
- Rare Diseases International, Plateforme Maladies Rares, 96 rue Didot, Paris, 75014, France
| | - Ana Rath
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, 96 rue Didot, Paris, 75014, France
| | - Roberta Anido
- Federación Argentina de Enfermedades Poco Frecuentes, Antonino Ferrari 1044, 1424, Buenos Aires, Argentina
| | - Diego Ardigò
- Chiesi Farmaceutici SpA, Via Paradigna 131/A, Parma, Italy
| | - Gareth Baynam
- Rare Care Centre, Western Australian Department of Health, Perth Children's Hospital and Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Hugh Dawkins
- School of Medicine, The University of Notre Dame Australia (UNDA), 160 Oxford St, Darlinghurst, NSW, Australia
| | - Ada Hamosh
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1008, Baltimore, MD, 21287-4922, USA
| | - Yann Le Cam
- EURORDIS - Rare Diseases Europe, Plateforme Maladies Rares, 96 rue Didot, Paris, 75014, France
| | - Helen Malherbe
- Rare Diseases South Africa, 63 Peter Place, Bryanston, Sandton, Johannesburg, South Africa
- Centre for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Caron M Molster
- Office of Population Health Genomics, West Australia Department of Health, Level 3, C Block, 189 Royal Street, East Perth, WA, 6004, Australia
| | - Lucia Monaco
- International Rare Disease Research Consortium (IRDiRC), Paris, France
| | - Carmencita D Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil Street, Taft Ave, Ermita, Manila, 1000, Philippines
| | - Anne R Pariser
- International Rare Disease Research Consortium (IRDiRC), Paris, France
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, 10 Discovery Drive, Farmington, CT, 06032, USA
| | - Charlotte Rodwell
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, 96 rue Didot, Paris, 75014, France
| | - Franz Schaefer
- European Rare Kidney Disease Reference Network (ERKNet), Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Stefanie Weber
- Department K - Code Systems and Registers, Federal Institute for Drugs and Medical Devices, Kurt-Georg- Kiesinger-Allee 3, D-53175, Bonn, Germany
| | - Flaminia Macchia
- Rare Diseases International, Plateforme Maladies Rares, 96 rue Didot, Paris, 75014, France
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Obici L, Callaghan R, Ablett J, Bibiloni C, Bueser T, Conceição I, Dongiglio F, Farrugia A, Knebel F, Lane T, Larsson LO, Morier A, Nicholas V, Coelho T. Consensus recommendations on holistic care in hereditary ATTR amyloidosis: an international Delphi survey of patient advocates and multidisciplinary healthcare professionals. BMJ Open 2023; 13:e073130. [PMID: 37669844 PMCID: PMC10481833 DOI: 10.1136/bmjopen-2023-073130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Hereditary transthyretin-mediated amyloidosis is a rare, progressive and potentially life-limiting multisystem disease, affecting every aspect of a patient's life. OBJECTIVES This online international Delphi survey aimed to evolve clinical-patient-led practical guidance, to inspire and encourage a holistic approach to care that is managed in specialist settings by multidisciplinary teams and supported by allied healthcare professionals (HCPs) and patient advocacy groups (PAGs). DESIGN A 14-member joint patient advocate-HCP primary panel was convened including representation from PAGs and key clinical specialties (neurology, cardiology, internal medicine, physiotherapy, clinical psychology, dietetics and specialist nursing). Guidance evolved on the care provision needed to support seven core goals: early diagnosis and treatment; disease monitoring and organisation of care; maintenance of physical and mental health; family-centred care and caregiver support; patient-doctor dialogue; access to social support and social networking. PARTICIPANTS From June to October 2022, 252 HCPs and 51 PAG representatives from 27 countries were invited to participate in a Delphi survey. Of the 122 respondents who answered at least one survey question, most were HCPs (100, 82%) from specialist centres; the remainder were PAG representatives (22, 18%). MAIN OUTCOME MEASURE Both level of agreement and feasibility in practice of each recommendation was tested by two anonymised online Delphi voting rounds. RESULTS Based on an a priori threshold for consensus of ≥75% agreement, the clinical-patient community endorsed all but one recommendation. However, only 17/49 (35%) recommendations were identified by most HCPs as a core part of routine care; the remainder (32/49 (65%)) were identified as part of core care by <50% of HCPs respondents, or as largely achievable by 30%-45% of HCPs. By comparison, PAGs recorded lower implementation levels. CONCLUSIONS Further consideration is needed on how to evolve multidisciplinary services (supported by allied HCPs and PAGs) to address the complex needs of those affected by this disease.
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Affiliation(s)
- Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Catilena Bibiloni
- Asociación Balear de la Enfermedad de Andrade, Palma de Mallorca, Spain
- Amyloïdosis Alliance, Marseille, France
| | - Teofila Bueser
- Southeast Genomic Medicine Service Alliance, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Isabel Conceição
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte-HSM; Lisbon University - FML, Lisbon, Portugal
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Disease Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Agnès Farrugia
- Amyloïdosis Alliance, Marseille, France
- Association Française Contre l'Amylose, Marseille, France
| | - Fabian Knebel
- Clinic for Internal Medicine II: Cardiology, Sana Klinikum Lichtenberg, Berlin, Germany
- Amyloidosis Center Charité Berlin, Berlin, Germany
| | - Thirusha Lane
- Patient Advocacy and Engagement, Alnylam Pharmaceuticals, Maidenhead, UK
| | | | | | | | - Teresa Coelho
- Familial Amyloidosis Clinic Unit, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- European Reference Network - Euro-NMD, Paris, France
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Postma MJ, Noone D, Rozenbaum MH, Carter JA, Botteman MF, Fenwick E, Garrison LP. Assessing the value of orphan drugs using conventional cost-effectiveness analysis: Is it fit for purpose? Orphanet J Rare Dis 2022; 17:157. [PMID: 35382853 PMCID: PMC8981887 DOI: 10.1186/s13023-022-02283-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Conventional cost-effectiveness analysis—i.e., assessing pharmaceuticals through a cost per quality-adjusted life year (QALY) framework—originated from a societal commitment to maximize population health given limited resources. This "extra-welfarist" approach has produced pricing and reimbursement systems that are not well- aligned with the unique considerations of orphan drugs. This framework has been slow to evolve along with our increased understanding of the impact of rare diseases, which in turn has complicated the assessment of orphan drugs meant to treat rare diseases. Herein, we (i) discuss the limitations of conventional cost-effectiveness analysis as applied to assessing access to, as well as the pricing and reimbursement of, orphan drugs, (ii) critically appraise alternative and supplemental approaches, and (iii) offer insights on plausible steps forward.
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Affiliation(s)
- Maarten J Postma
- Department of Health Sciences, University Medical Center, University of Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Declan Noone
- European Haemophilia Consortium, Brussels, Belgium
| | | | | | | | | | - Louis P Garrison
- Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, USA.
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Willmen T, Völkel L, Ronicke S, Hirsch MC, Kaufeld J, Rychlik RP, Wagner AD. Health economic benefits through the use of diagnostic support systems and expert knowledge. BMC Health Serv Res 2021; 21:947. [PMID: 34503507 PMCID: PMC8431907 DOI: 10.1186/s12913-021-06926-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/20/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Rare diseases are difficult to diagnose. Due to their rarity, heterogeneity, and variability, rare diseases often result not only in extensive diagnostic tests and imaging studies, but also in unnecessary repetitions of examinations, which places a greater overall burden on the healthcare system. Diagnostic decision support systems (DDSS) optimized by rare disease experts and used early by primary care physicians and specialists are able to significantly shorten diagnostic processes. The objective of this study was to evaluate reductions in diagnostic costs incurred in rare disease cases brought about by rapid referral to an expert and diagnostic decision support systems. METHODS Retrospectively, diagnostic costs from disease onset to diagnosis were analyzed in 78 patient cases from the outpatient clinic for rare inflammatory systemic diseases at Hannover Medical School. From the onset of the first symptoms, all diagnostic measures related to the disease were taken from the patient files and documented for each day. The basis for the health economic calculations was the Einheitlicher Bewertungsmaßstab (EBM) used in Germany for statutory health insurance, which assigns a fixed flat rate to the various medical services. For 76 cases we also calculated the cost savings that would have been achieved by the diagnosis support system Ada DX applied by an expert. RESULTS The expert was able to achieve significant savings for patients with long courses of disease. On average, the expert needed only 27 % of the total costs incurred in the individual treatment odysseys to make the correct diagnosis. The expert also needed significantly less time and avoided unnecessary examination repetitions. If a DDSS had been applied early in the 76 cases studied, only 51-68 % of the total costs would have incurred and the diagnosis would have been made earlier. Earlier diagnosis would have significantly reduced costs. CONCLUSION The study showed that significant savings in the diagnostic process of rare diseases can be achieved through rapid referral to an expert and the use of DDSS. Faster diagnosis not only achieves savings, but also enables the right therapy and thus an increase in the quality of life for patients.
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Affiliation(s)
- Tina Willmen
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Lukas Völkel
- Institute for Empirical Health Economics, Burscheid, Germany
| | - Simon Ronicke
- Medical Clinic for Nephrology and Internal Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Martin C Hirsch
- Institute for AI in Medicine, University Hospital of Giessen and Marburg, Marburg, Germany
- Ada Health GmbH, Berlin, Germany
| | - Jessica Kaufeld
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | | | - Annette D Wagner
- Department of Nephrology, Hannover Medical School, Hanover, Germany.
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Zimmermann BM, Eichinger J, Baumgartner MR. A systematic review of moral reasons on orphan drug reimbursement. Orphanet J Rare Dis 2021; 16:292. [PMID: 34193232 PMCID: PMC8247078 DOI: 10.1186/s13023-021-01925-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/20/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients suffering from rare diseases, they are usually very expensive. The growing number of approved OMPs increases their budget impact despite their low prevalence, making it pressing to find solutions to ethical challenges on how to fairly allocate scarce healthcare resources under this context. One potential solution could be to grant OMPs special status when considering them for reimbursement, meaning that they are subject to different, and less stringent criteria than other drugs. This study aims to provide a systematic analysis of moral reasons for and against such a special status for the reimbursement of OMPs in publicly funded healthcare systems from a multidisciplinary perspective. RESULTS With a systematic review of reasons, we identified 39 reasons represented in 243 articles (scientific and grey literature) for and against special status for the reimbursement of OMPs, then categorized them into nine topics. Taking a multidisciplinary perspective, we found that most articles came from health policy (n = 103) and health economics (n = 49). More articles took the position for a special status of OMPs (n = 97) than those against it (n = 31) and there was a larger number of reasons identified in favour (29 reasons) than against (10 reasons) this special status. CONCLUSION Results suggest that OMP reimbursement issues should be assessed and analysed from a multidisciplinary perspective. Despite the higher occurrence of reasons and articles in favour of a special status, there is no clear-cut solution for this ethical challenge. The binary perspective of whether or not OMPs should be granted special status oversimplifies the issue: both OMPs and rare diseases are too heterogeneous in their characteristics for such a binary perspective. Thus, the scientific debate should focus less on the question of disease prevalence but rather on how the important variability of different OMPs concerning e.g. target population, cost-effectiveness, level of evidence or mechanism of action could be meaningfully addressed and implemented in Health Technology Assessments.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany.
| | - Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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González-Moreno J, Gaya-Barroso A, Losada-López I, Rodríguez A, Bosch-Rovira T, Ripoll-Vera T, Usón M, Figuerola A, Descals C, Montalà C, Ferrer-Nadal MA, Cisneros-Barroso E. Val50Met hereditary transthyretin amyloidosis: not just a medical problem, but a psychosocial burden. Orphanet J Rare Dis 2021; 16:266. [PMID: 34112225 PMCID: PMC8191011 DOI: 10.1186/s13023-021-01910-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hereditary transthyretin (TTR) amyloidosis (ATTRv) is a heterogeneous disease with a clinical presentation that varies according to geographical area and TTR mutation. The symptoms of Val50Met-ATTRv are mainly neuropathic and progress to complete disability and death in most untreated patients within 10 to 15 years of diagnosis. The neurological effects may also be accompanied by gastrointestinal impairment, cardiomyopathy, nephropathy and/or ocular deposition. The disease is thus associated with a high degree of patient disability. Accordingly, we aimed to describe the psychosocial burden associated with ATTRv in a group of patients, asymptomatic Val50Met carriers, relatives and caregivers in the endemic focus of the disease in Majorca via a survey addressing various aspects related to psychosocial burden. We performed a an observational, descriptive, cross-sectional and multicentre study in order to analyze the prevalence of self-reported impact of ATTRv disease upon their daily life. In addition to the self-knowledge, fear and burden related to the disease. The survey was disseminated during the regular follow up at the outpatient clinic of the Hospital Universitario Son Llàtzer and during the meetings organized by the Andrade's Disease patients' advocacy group from the Balearic Islands. These meetings were attended also by subjects followed up by the Hospital Universitario Son Espases and their caregivers and relatives. Survey was self-administrated. No intervention was done by the investigators. 85 subjects completed the survey: 61 carrying the TTR-V50M variant and 24 caregivers or relatives. RESULTS Our study revealed that, although most of the population studied had had prior contact with ATTRv through affected relatives, there was still a lack of information regarding disease diagnosis. Fear of the genetic test result and psychological issues were common in our population. Moreover, the disease had a stronger impact on the daily life of our patients than that of our asymptomatic carriers. Autonomic symptoms were the main source of burden for relatives and caregivers. CONCLUSION Our survey results show high psychosocial burden associated with Val50Met-ATTRv in our area.
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Affiliation(s)
- Juan González-Moreno
- Servicio de Medicina Interna, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
| | - Aina Gaya-Barroso
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
| | - Inés Losada-López
- Servicio de Medicina Interna, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
| | - Adrián Rodríguez
- Servicio de Medicina Interna, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
| | - Teresa Bosch-Rovira
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
- Servicio de Medicina Interna, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, 07120, Palma, Balearic Islands, Spain
| | - Tomás Ripoll-Vera
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
- Servicio de Cardiología, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Mercedes Usón
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
- Servicio de Neurología, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Antoni Figuerola
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
- Servicio de Neurología, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Cristina Descals
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
- Servicio de Neurología, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Carles Montalà
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
- Servicio de Neurología, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - María Asunción Ferrer-Nadal
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain
- Servicio de Nefrología, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Eugenia Cisneros-Barroso
- Servicio de Medicina Interna, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain.
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Balearic Islands, Spain.
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Reddy SR, Chang E, Tarbox MH, Broder MS, Tieu RS, Guthrie S, Vera-Llonch M, Pollock MR. The Clinical and Economic Burden of Newly Diagnosed Hereditary Transthyretin (ATTRv) Amyloidosis: A Retrospective Analysis of Claims Data. Neurol Ther 2020; 9:473-482. [PMID: 32451849 PMCID: PMC7606386 DOI: 10.1007/s40120-020-00194-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Little is known about the burden of hereditary transthyretin (ATTRv) amyloidosis, a genetic, progressive, and fatal disease caused by extracellular deposition of transthyretin amyloid fibrils. The study's aim was to estimate costs and disease burden associated with ATTRv amyloidosis in a real-world setting. METHODS Using IBM® MarketScan® Commercial and Medicare Supplemental data, we identified patients at least 18 years of age with newly diagnosed ATTRv amyloidosis. Diagnosis required at least one medical claim with relevant diagnosis code (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] 277.30-.31, 277.39; ICD-10-CM E85.0-.4, E85.89, E85.9) between January 1, 2014 and December 31, 2016, and at least one additional criterion occurring during study period (2013-2017): at least 15 days diflunisal use without more than a 30-day gap; liver transplant; or claim with codes E85.1 or E85.2. First diagnosis date was study index. Continuous enrollment 1-year pre-index (baseline) and post-index (follow-up) was required. Patients with baseline amyloidosis diagnosis were excluded. Outcomes of interest were comorbidities and 1-year follow-up healthcare utilization and costs (also reported quarterly). RESULTS Among 185 qualifying patients, mean age was 59.2 years (standard deviation 15.2), 54.1% were female, and baseline Charlson comorbidity index was 2.2 (2.5). Neuropathy (30.3%), diabetes (27.0%), and cardiovascular-related comorbidities, including dyspnea (25.9%) and congestive heart failure (21.6%), were common during follow-up. Nearly a quarter of patients (24.9%) were hospitalized during follow-up. Most hospitalizations and emergency department visits occurred in the first quarter post-diagnosis (18.9%, 17.8%, respectively) and dropped in subsequent quarters. The annual mean total cost was $64,066, with inpatient services contributing the majority of the expenses ($34,461), followed by outpatient ($23,853), and then pharmacy ($5752). As with utilization, costs were highest in the first quarter post-diagnosis and dropped in subsequent quarters. CONCLUSION Patients newly diagnosed with ATTRv amyloidosis have substantial healthcare utilization and costs in the first year, primarily the initial months, post-diagnosis. Further research should examine later costs associated with disease progression and end-of-life care.
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Affiliation(s)
- Sheila R Reddy
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Marian H Tarbox
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Ryan S Tieu
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
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