Impact of Cumulative Corticosteroid Dosage on Preventable Hospitalization among Taiwanese Patients with Ankylosing Spondylitis and Inflammatory Bowel Disease.

Jung-Sheng Chen,Beth I Wallace,Chelsea A Harris,Kevin C Chung,Lu Wang,Mochuan Liu,Chang-Fu Kuo

doi:10.3390/jcm8050614

Abstract

Background: Corticosteroids are commonly prescribed for autoimmune conditions, but their impact on preventable hospitalization rates is unclear. This study sought to investigate the effect of corticosteroid use on hospitalization for ambulatory care sensitive conditions among Taiwanese patients with ankylosing spondylitis (AS) or inflammatory bowel disease (IBD). Methods: This was a retrospective cohort study using adults in the Taiwan National Health Insurance Research database receiving a new diagnosis of AS (n = 40,747) or IBD (n = 4290) between January 2002 and June 2013. Our main outcome measure was odds of preventable hospitalization for eight ambulatory care-sensitive conditions defined by the Agency for Healthcare Research and Quality. Results: In the first quarter (three months) following diagnosis, corticosteroid usage was common among patients with AS and IBD (18.5% and 30%, respectively). For every 100 mg increase in corticosteroid dose per quarter, adjusted odds of preventable hospitalization in the following quarter increased by 5.5% for patients with AS (aOR = 1.055, 95% CI 1.037–1.074) and 6.4% for those with IBD (aOR = 1.064, 95% CI 1.046–1.082). Conclusions: Relatively low doses of corticosteroids significantly increase AS and IBD patients’ short-term odds of hospitalization for ambulatory care-sensitive conditions. As recommended by current clinical guidelines, physicians should use corticosteroids sparingly in these populations, and prioritize initiation/escalation of disease-modifying anti-rheumatic drugs for long-term management. If corticosteroids cannot be avoided, patients may require monitoring and/or prophylaxis for corticosteroid-associated comorbidities (e.g., diabetes) which can result in preventable hospitalizations.

Highlights

Our global healthcare environment has become increasingly focused on maximizing value
We used validated claims definitions for inflammatory bowel disease (IBD) [18] and ankylosing spondylitis (AS) [19] to identify Taiwanese patients enrolled in National Health Insurance (NHI) between January 2002 and June 2013 who received a new diagnosis of either condition while enrolled (Supplemental Figure S1) (Supplemental Table S1)
We explored the unadjusted relationship between cumulative yearly corticosteroid dose and number of preventable hospitalizations over the study period (Figure 1)

Summary

Introduction

Our global healthcare environment has become increasingly focused on maximizing value This is of particular importance when managing high-cost, low-prevalence conditions such as autoimmune diseases, for which expensive biologic disease-modifying anti-rheumatic drug (biologic DMARD) treatments are often required for management of more severe patients. There have been limited studies of corticosteroid safety and effectiveness in patients of Asian descent, despite previous work showing high prevalence of autoimmune conditions [14] and unique adverse DMARD side effect profiles [15,16] in such populations It is; important to understand how corticosteroids impact the risk-benefit relationship between treating autoimmune disease and predisposing patients to the corticosteroid-related adverse events discussed above, in Asian populations. If corticosteroids cannot be avoided, patients may require monitoring and/or prophylaxis for corticosteroid-associated comorbidities (e.g., diabetes) which can result in preventable hospitalizations

Methods

Results

Conclusion