Higher Healthcare Costs in Year Before Diagnosis, Analysis Finds
Study compares Medicare recipients without AAV to those eventually diagnosed
In the year before being diagnosed with ANCA-associated vasculitis (AAV), Medicare beneficiaries had significantly higher use and costs of healthcare than those without AAV, an analysis found.
According to researchers, earlier identification of AAV is necessary to provide patients with appropriate care and potentially reduce costs and healthcare use.
Future studies should explore how delays in diagnosis affect long-term AAV outcomes and whether healthcare use could help detect AAV in those with nonspecific symptoms, they noted.
Findings from the analysis were detailed in the study “Health care costs and utilization prior to diagnosis of antineutrophil cytoplasmic antibody vasculitis in Medicare beneficiaries,” published in the Journal of Managed Care & Specialty Pharmacy.
AAV is a group of autoimmune disorders marked by inflammation and damage to small- and medium-sized blood vessels. Depending on where blood vessel damage occurs in the body, AAV can cause different symptoms, some of which vary from patient to patient and are nonspecific.
As a result, people with AAV can experience delays in diagnosis, with an increase in healthcare use and costs in advance of that finding.
This study, led by researchers at the University of North Carolina, aimed to evaluate whether Medicare beneficiaries who were eventually diagnosed with AAV had higher healthcare utilization and costs in the year before diagnosis than beneficiaries without AAV.
“To our knowledge, burden of [AAV] manifestation during the prediagnosis period has not been characterized in the Medicare population,” the team wrote.
The study and its results
Researchers collected data from 2015–16 on Medicare Part A/B claims and Part D prescription medications. Part A covers inpatient hospital care, nursing, hospice, and home care, while Part B covers medically necessary and preventive services.
The analysis included two subgroups: beneficiaries with Parts A/B medical coverage only (AB); and those with Part A/B medical coverage plus Part D prescription coverage (ABD).
Beneficiaries with newly diagnosed AAV were identified by having one or more inpatient claims, or two or more non-inpatient claims filed at least seven days apart in 2016, with no AAV claims in the previous year. An equally sized group of age- and sex-matched beneficiaries without AAV were included as a comparison.
Among AB claims, there were 1,460 beneficiaries (730 with AAV and 730 without AAV) with a mean age of 71.8 years, of whom 52.2% were female. There were 3,252 ABD beneficiaries (1,626 with AAV and 1,626 without AAV) with a mean age of 70.4 years, of whom 61.9% were female.
Granulomatosis with polyangiitis (GPA) was the most common AAV subtype in both beneficiary groups (about 73%), followed by microscopic polyangiitis (MPA). Overall, 285 AAV patients (12.1%) also had end-stage kidney disease compared with 24 (1.0%) beneficiaries without AAV.
In the year before diagnosis, beneficiaries with AAV had a higher mean unadjusted total Part A payments than those without AAV ($18,772 vs. $8,568) and higher Part B payments ($3,414 vs. $1,513). In adjusted models, Medicare Part A/B payments were almost three times higher for patients with AAV than for those without the disease ($21,582 vs. $7,346). Total Medicare Part B medicine payments were also significantly higher.
Healthcare use
AAV patients had significantly higher healthcare use across all categories. Compared with beneficiaries without AAV, acute inpatient hospital stays in those with AAV were 2.77 times higher, hospital outpatient visits were 2.69 times higher, and imaging tests were 2.40 times more frequent.
In the ABD group, AAV beneficiaries had a higher mean unadjusted total Part A payments than those without AAV ($23,445 vs. $10,136) and higher Part B payments ($4,381 vs. $1,907). Adjusted models showed Medicare Part A/B payments were almost three times higher for patients with AAV compared with those without AAV. Medicare Part B and Part D spending for medications was also significantly higher for AAV patients.
Like the AB group, ABD beneficiaries with AAV experienced significantly more healthcare use across all categories. For those with AAV, hospital outpatient visits occurred 3.08 times more often, acute inpatient stays were 2.60 times higher, and imaging tests were 2.40 times more frequent.
AAV patients had a significantly greater mean number of 30-day supply prescriptions than beneficiaries without AAV (63.57 vs. 53.29). AAV patients were also more than three times more likely to use corticosteroids and seven times more likely to use immunosuppressants than those without AAV. Beneficiaries with AAV also had a 53% higher odd of using opioids. No differences were seen for nonsteroidal anti-inflammatory drugs.
After adjusting for demographic and insurance-related factors, total costs for AAV beneficiaries were significantly higher in each quarter than in controls. In the first three months preceding a diagnosis of AAV, total costs in people with possible AAV were nearly 4.5 times higher than in those who did not have AAV. In the following three quarters, total expenditures ranged from 2.01 to 2.47 times higher.
Similar to the AB group, total Medicare Parts A, B, and D costs for AAV patients were also significantly higher in each quarter. In the three months before diagnosis, AAV beneficiaries had a total Part A, B, and D costs that were almost four times higher than those seen in beneficiaries without AAV. In the following three quarters, total expenditures ranged from 2.14 to 2.4 times higher.
“This study illustrates the high burden of [AAV] to the health care system even before formal diagnosis,” the team wrote. “Earlier identification of [AAV] is necessary to guide patients to appropriate care and potentially reduce costs and morbidity.”
“Future studies should further explore how delays in [AAV] diagnosis affect long-term patient outcomes and if specific health care utilization could be used to develop a predictive risk tool that allows providers to detect the nonspecific symptoms of [AAV],” they wrote.
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