Projected Health and Economic Burden of Comorbid Gout and Chronic Kidney Disease in a Virtual US Population: A Microsimulation Study.

IF 2.9 3区医学 Q2 RHEUMATOLOGY

Rheumatology and Therapy Pub Date : 2024-08-01 Epub Date: 2024-06-05 DOI:10.1007/s40744-024-00681-2

Joshua Card-Gowers, Lise Retat, Ada Kumar, Brad A Marder, Lissa Padnick-Silver, Brian LaMoreaux, Laura Webber

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Abstract

Introduction: Gout, a common comorbidity of chronic kidney disease (CKD), is associated with high morbidity and healthcare utilization. However, a large proportion of gout remains undermanaged or untreated which may lead to worse patient outcomes and greater healthcare costs. This study estimates the present and future health and economic burden of controlled and uncontrolled gout in a virtual United States (US) CKD population.

Methods: A validated microsimulation model was used to project the burden of gout in patients with CKD in the USA through 2035. Databases were utilized to build a virtual CKD population of "individuals" with controlled or uncontrolled gout. Modelling assumptions were made on the basis of the literature, which was sparse in some cases. Health and economic outcomes with the current care (baseline) scenario were evaluated, along with potential benefits of urate-lowering intervention scenarios.

Results: The prevalence of comorbid gout and CKD in the USA was projected to increase by 29%, from 7.9 million in 2023 to 9.6 million in 2035 in the baseline scenario. Gout flares, tophi, and comorbidity development were also projected to increase markedly through 2035, with the economic burden of gout in the CKD population subsequently increasing from $38.9 billion in 2023 to $47.3 billion in 2035. An increased use of oral urate-lowering therapies in undermanaged patients, and pegloticase use in patients refractory to oral urate-lowering therapies were also project to result in 744,000 and 353,000 fewer uncontrolled gout cases, respectively, by 2035. Marked reductions in complications and costs ensued.

Conclusions: This study projected a substantial increase in comorbid gout and CKD. However, improved use of urate-lowering interventions could mitigate this growth and reduce the health and economic burdens of gout.

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虚拟美国人口中痛风和慢性肾病并发症的健康和经济负担预测：微观模拟研究

导言：痛风是慢性肾脏病（CKD）的常见并发症，发病率和医疗费用都很高。然而，很大一部分痛风患者仍未得到充分管理或治疗，这可能会导致患者病情恶化和医疗费用增加。本研究估算了在一个虚拟的美国慢性肾脏病人群中，已控制和未控制的痛风所带来的当前和未来的健康与经济负担：方法：使用一个经过验证的微观模拟模型来预测到 2035 年美国慢性肾脏病患者的痛风负担。利用数据库建立了一个由痛风得到控制或未得到控制的 "个体 "组成的虚拟 CKD 群体。建模假设以文献为基础，而文献在某些情况下是稀缺的。评估了当前治疗方案（基线）的健康和经济效益，以及降尿酸干预方案的潜在效益：结果：在基线方案中，预计美国痛风和慢性肾脏病合并症的发病率将增加 29%，从 2023 年的 790 万增加到 2035 年的 960 万。预计到 2035 年，痛风发作、丘疹和合并症的发展也将显著增加，CKD 患者痛风造成的经济负担将从 2023 年的 389 亿美元增加到 2035 年的 473 亿美元。预计到 2035 年，在病情未得到充分控制的患者中增加口服降尿酸治疗药物的使用，以及在口服降尿酸治疗药物难治性患者中使用培高替尼酶，也将使未得到控制的痛风病例分别减少 744,000 例和 353,000 例。并发症和成本随之显著降低：这项研究预计痛风和慢性肾脏病的合并症将大幅增加。结论：这项研究预测痛风和慢性肾脏病的合并症将大幅增加，然而，改善降尿酸干预措施的使用可以缓解这一增长，并减少痛风带来的健康和经济负担。

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来源期刊

Rheumatology and Therapy RHEUMATOLOGY-

CiteScore

6.00

自引率

5.30%

发文量

审稿时长

6 weeks

期刊介绍： Aims and Scope Rheumatology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of rheumatologic therapies. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. Areas of focus include, but are not limited to, rheumatoid arthritis, gout, gouty arthritis, psoriatic arthritis, osteoarthritis, juvenile idiopathic/rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis, Pompe’s disease, inflammatory joint conditions, musculoskeletal conditions, systemic sclerosis, and fibromyalgia. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial protocols, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Rheumatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Ethics and Disclosures The journal is a member of the Committee on Publication Ethics (COPE) and subscribes to its principles on how to deal with acts of misconduct thereby committing to investigate allegations of misconduct in order to ensure the integrity of research. Content in this journal is peer-reviewed (Single-blind). For more information on our publishing ethics policies, please see here: https://www.springer.com/gp/editorial-policies Rapid Publication The journal’s rapid publication timelines aim for a peer review decision within 2 weeks of submission. If an article is accepted it will be published online 3-4 weeks from acceptance. These rapid timelines are achieved through the combination of a dedicated in-house editorial team, who closely manage article workflow, and an extensive Editorial and Advisory Board who assist with rapid peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid and efficient communication of the latest research and reviews, allowing the advancement of rheumatologic therapies. 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