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Degli Esposti L, Dovizio M, Perrone V, Veronesi C, Andretta M, Bacca M, Barbieri A, Bartolini F, Cavaliere A, Chinellato A, Ciaccia A, Cillo M, Citraro R, Costantini A, Dell'Orco S, Ferrante F, Gentile S, Grego S, Mancini D, Moscogiuri R, Mosele E, Pagliaro R, Procacci C, Re D, Santoleri F, Ubertazzo L, Vercellone A, Ramirez de Arellano A, Gigliotti G, Quartuccio L. Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy. Adv Ther 2023; 40:5338-5353. [PMID: 37787877 PMCID: PMC10611841 DOI: 10.1007/s12325-023-02681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare autoimmune diseases triggering inflammation of small vessels. This real-world analysis was focused on the most common AAV forms, granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), to describe patients' demographic and clinical characteristics, therapeutic management, disease progression, and the related economic burden. METHODS A retrospective analysis was conducted on administrative databases of a representative sample of Italian healthcare entities, covering approximately 12 million residents. Between January 2010 and December 2020, adult GPA patients were identified by payment waiver code or hospitalization discharge diagnosis, and MPA patients by payment waiver code with or without hospitalization discharge diagnosis. Clinical outcomes were evaluated through AAV-related hospitalizations, renal failure onset, and mortality. Economic analysis included healthcare resource utilization deriving from drugs, hospitalizations, and outpatient specialist services. The related mean direct costs year/patient were also calculated in patients stratified by presence/absence of glucocorticoid therapy and type of inclusion criterion (hospitalization/payment waiver code). RESULTS Overall, 859 AAV patients were divided into GPA (n = 713; 83%) and MPA (n = 146; 17%) cohorts. Outcome indicators highlighted a clinically worse phenotype associated with GPA compared to MPA. Cost analysis during follow-up showed tendentially increased expenditures in glucocorticoid-treated patients versus untreated (overall AAV: €8728 vs. €7911; GPA: €9292 vs. €9143; MPA: €5967 vs. €2390), mainly driven by drugs (AAV: €2404 vs. €874; GPA: €2510 vs. €878; MPA: €1881 vs. €854) and hospitalizations. CONCLUSION Among AAV forms, GPA resulted in a worse clinical picture, higher mortality, and increased costs. This is the first real-world pharmaco-economic analysis on AAV patients stratified by glucocorticoid use on disease management expenditures. In both GPA and MPA patients, glucocorticoid treatment resulted in higher healthcare costs, mostly attributable to medications, and then hospitalizations, confirming the clinical complexity and economic burden for management of patients with autoimmune diseases under chronic immunosuppression.
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Affiliation(s)
- Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy.
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | - Chiara Veronesi
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | | | | | | | | | | | | | | | | | - Rita Citraro
- Dipartimento di Scienze della Salute, Università Magna Grecia di Catanzaro, Unità Operativa Di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria "Mater Domini", Catanzaro, Italy
| | | | | | | | - Simona Gentile
- Direzione Generale per la Salute Regione Molise, Campobasso, Italy
| | | | | | | | - Elena Mosele
- Azienda ULSS 7 Pedemontana, Bassano del Grappa, VI, Italy
| | | | | | | | - Fiorenzo Santoleri
- Dipartimento di Scienze della Salute, Università Magna Grecia di Catanzaro, Unità Operativa Di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria "Mater Domini", Catanzaro, Italy
| | | | | | | | | | - Luca Quartuccio
- Dipartimento di Medicina (DAME), Clinica di Reumatologia, Università degli Studi di Udine, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
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Perrone V, Dovizio M, Sangiorgi D, Andretta M, Bartolini F, Cavaliere A, Ciaccia A, Chinellato A, Costantini A, Dell’Orco S, Ferrante F, Gentile S, Lavalle A, Moscogiuri R, Mosele E, Procacci C, Re D, Santoleri F, Roccia A, Maggiolo F, Degli Esposti L. Healthcare Resource Consumption and Related Costs in Patients on Antiretroviral Therapies: Findings from Real-World Data in Italy. Int J Environ Res Public Health 2023; 20:3789. [PMID: 36900813 PMCID: PMC10000772 DOI: 10.3390/ijerph20053789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This real-world analysis conducted on administrative databases of a sample of Italian healthcare entities was aimed at describing the role of therapeutic pathways and drug utilization in terms of adherence, persistence, and therapy discontinuation in HIV-infected patients under antiretroviral therapies (ART) and Tenofovir Alafenamide (TAF)-based regimens on healthcare resource consumption and related direct healthcare costs. Between 2015 and 2019, adults (≥18 years) prescribed with TAF-based therapies were identified and characterized in the year prior to the first prescription (index-date) for TAF-based therapies and followed-up until the end of data availability. Overall, 2658 ART-treated patients were included, 1198 of which were under a TAF-based regimen. TAF-based therapies were associated with elevated percentages of adherence (83.3% patients with proportion of days covered, PDC > 95% and 90.6% with PDC > 85%) and persistence (78.5%). The discontinuation rate was low in TAF-treated patients, ranging from 3.3% in TAF-switchers to 5% in naïve. Persistent patients had lower overall mean annual healthcare expenditures (EUR 11,106 in persistent vs. EUR 12,380 in non-persistent, p = 0.005), and this trend was statistically significant also for costs related to HIV hospitalizations. These findings suggest that a better therapeutic management of HIV infection might result in positive clinical and economic outcomes.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | | | | | | | - Andrea Ciaccia
- Servizio Farmaceutico Territoriale ASL Foggia, 71121 Foggia, Italy
| | | | | | | | | | - Simona Gentile
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | - Antonella Lavalle
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | | | - Elena Mosele
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 7 Pedemontana, 36061 Bassano del Grappa, Italy
| | | | | | | | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
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