PAM23: VERTEBRAL FRACTURES AMONG GLUCOCORTICOID PATIENTS SIGNIFICANTLY INCREASE MEDICAL CARE COSTS

Abstract

BACKGROUND: Previous studies have demonstrated that high levels of glucocorticoid (GC) exposure are associated with increased fracture risk. However, none has reported potential cost impacts. OBJECTIVE: To estimate the marginal costs from vertebral fractures among GC patients. METHODS: Subjects 18–64 years old with different GC exposure levels, with and without fractures, were selected (n = 50,191). GC exposure was categorized into three levels: high (3+ claims of continuous use or> 9.5 prednisone-equivalent mg/day), low (other GC use), and no GC use. Fractures, comorbid conditions, and costs were determined 15 months before and up to 3.5 years after index date. Regression models were used to estimate the marginal effects of vertebral fractures on pharmacy costs, medical costs and total costs. The models controlled for age, gender, pre-index date costs, GC exposure/fracture combinations, and pre-index and new post-index date comorbid conditions. RESULTS: Vertebral fractures led to significant per-member per-month (PMPM) cost increases in each GC exposure group. Furthermore, the additional increase in marginal cost from vertebral fracture on total PMPM costs among high GC patients versus low GC patients was 83% ($170; p < 0.001). Differential increases in pharmacy and medical PMPM costs between high and low GC patients were 151% ($56; p < 0.01) and 68% ($115; p = 0.014), respectively. CONCLUSIONS: Vertebral fractures were associated with increased PMPM costs, holding constant patients' underlying conditions. High GC patients had greater PMPM increases from vertebral fractures compared to those with low or no GC exposure. These findings provide new evidence that vertebral fractures have substantial increases on treatment costs among GC patients. Also, greater PMPM increases from vertebral fractures among high GC patients versus low GC patients suggest vertebral fractures increase in severity with GC exposure. These results also support the need for adjuvant therapy to reduce fracture risk and associated morbidities.