THU0652 THE ECONOMIC BURDEN OF ANCA-ASSOCIATED VASCULITIS IN GERMANY – A CLAIMS DATA STUDY

Abstract

Background ANCA-associated vasculitis AAV is a rare systemic disease, characterized by recurrent episodes of systemic inflammation. It is a severe disease associated with hospitalization, risk of renal failure and a therapy inducing serious side effects. The economic impact of AAV to the German health care system is currently not well understood. Objectives The aim of this study was to better understand and quantify the economic burden of AAV in Germany. Therefore, selected aspects, such as prevalence and incidence, frequency of hospitalization, frequency of intensive care unit (ICU) stays and treatments costs, were systematically assessed in a claims data study. Methods Longitudinal data from years 2013 to 2016, provided by German statutory health insurance (SHI) companies from the InGef database have been analyzed representing an age- and gender stratified cohort of approx. 4 million insured persons representative for the German population. Results Prevalence and incidence data show that, in accordance with the previously published literature (1, 2), Granulomatosis with Polyangiitis (GPA) was more frequent than Microscopic Polyangiitis (MPA). On average, a combined prevalence of 256 : 1 000 000 (210 : 1 000 000 for GPA and 46 : 1 000 000 for MPA) was identified within the data set over the observed time period of 4 years (2013-2016). Incidence rates were found to be 46 : 1 000 000 (34 : 1 000 000 for GPA and 13 : 1 000 000 for MPA) within the same time period. Over the observed time period, prevalence and incidence rates remained stable. The majority of AAV (GPA and MPA) diagnoses were made in hospitals (61%), another 24% were diagnosed in the outpatient sector and 15% were diagnosed in both within one quarter. In total, 97% of newly diagnosed patients (GPA and MPA) were hospitalized within 4 years post diagnosis. Especially during the induction period (quarter of diagnosis and the following 2 quarters) 91% (GPA) to 95% (MPA) of the patients were hospitalized. Of these patients, approx. 60% were hospitalized due to GPA and MPA disease, showing the high rate of severe co-morbidities. Patients diagnosed with GPA and MPA were frequently treated at ICUs (in average 1 stay per quarter); in particular severe infections and renal involvements increased the likelihood of ICU stays. Treatment costs were highest during the induction period; within this period hospitalization represented the largest cost factor. Severe kidney disease, which occurred in 11,6% of GPA and 24,3% of MPA patients, induced total costs ranging between 131.521€ (GPA) to 145.472 € (MPA) over four years post diagnosis, with the induction period being most expensive (approx. 58.826 € to 50.339 € for GPA and MPA during the induction period). In the following years total treatment and hospital costs decreased, however remained high. Conclusion AAV represents an underestimated financial burden to the German healthcare system, especially during induction therapy. The high level of hospitalizations amongst AAV patients also represents a high usage of healthcare resources. Thus, AAV represents an underestimated cost factor for the German health care system, and better treatment options are desperately needed.