AAV Carries High Healthcare Costs, Italian Study Finds

ANCA-associated vasculitis (AAV) carries high healthcare costs for therapies and hospitalizations to treat the disease itself and related infections, a study in Italy has found.

The study, “Healthcare and economic burden of ANCA-associated vasculitis in Italy: an integrated analysis from clinical and administrative databases,” was published in Internal and Emergency Medicine.

AAV comprises a group of disorders characterized by inflammation in small blood vessels. Treatment typically aims to reduce inflammation and keep the disease in remission.

Both the disease itself and its treatments can cause a multitude of health-related complications, so people with AAV are theoretically more likely than the general population to require hospitalization or other healthcare resources. However, there isn’t much published data on healthcare costs associated with AAV.

In the new study, researchers at the University of Udine, in Italy, calculated AAV-associated healthcare costs in the Italian province of Udine, located in the northeast of Italy. To do this, they integrated data from multiple types of databases, including administrative and clinical databases.

The researchers included in their analysis 57 people who were diagnosed with AAV from 2010 to 2018. Most (77.2%) were positive for ANCA antibodies, and the average age at diagnosis was 54.5 years. The most common type of AAV was granulomatosis with polyangiitis (GPA, 35.1%), followed by eosinophilic granulomatosis with polyangiitis (EGPA, 36.8%), then microscopic polyangiitis (MPA, 28.1%).

Among these 57 patients, there were 126 recorded hospitalizations. The most common reason for hospitalization was AAV itself (as opposed to other health conditions), accounting for nearly half (47.6%) of hospitalizations. Overall, patients with ANCA antibodies required more frequent and earlier hospital admissions than those without such antibodies.

The researchers then calculated the average total healthcare cost of AAV to be €1,215,078 ($1,437,316) over the eight years, corresponding to €6,168 ($7,296) per patient-year. Notably, this cost was more than twice the cost associated with another blood vessel disease, giant cell arteritis, in the same region.

Costs for ANCA-positive individuals were markedly higher than for those who were ANCA-negative: €7,058 ($8,351) vs. €2,559 ($3,027) per patient-year. This is likely because ANCA positivity is linked to more acute disease, in this study and others.

Additionally, costs (per patient-year) were lower for people with EGPA (€2,329, or $2,755) than for those with GPA (€5,199 or $6,150) or MPA (€4,771 or $5,644).

This finding implies “a higher number of patients with limited disease or with a more favourable course of vasculitis in EGPA than in GPA or MPA,” the researchers wrote. “This observation further supports the consideration of EGPA as a separate entity among AAV.”

Among the direct costs of illness, the highest was hospitalization, which accounted for more than all other costs combined: €3,731 ($4,414) vs. €2,437 ($2,883) per patient-year.

“Even if rare, AAV are diseases showing a high level of economic source consumption for the healthcare system. The disease itself and the infectious complications during treatment still remain the main causes of hospitalization and related costs,” the researchers concluded.