Economic Impact of Early-in-Hospital Diagnosis and Initiation of Eculizumab in Atypical Haemolytic Uraemic Syndrome

Autor: Jeffrey Laurence, Michael P. Ryan, Christoph Gasteyger, Gilbert L’Italien, William Irish, Bonnie M. K. Donato
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Adult
Male
Pediatrics
medicine.medical_specialty
Multivariate analysis
Databases
Factual
medicine.medical_treatment
Cost-Benefit Analysis
Logistic regression
Antibodies
Monoclonal
Humanized
law.invention
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
law
Renal Dialysis
Statistical significance
Outcome Assessment
Health Care
Medicine
Humans
030212 general & internal medicine
Original Research Article
Dialysis
Atypical Hemolytic Uremic Syndrome
Retrospective Studies
Pharmacology
business.industry
030503 health policy & services
Health Policy
Public Health
Environmental and Occupational Health
Retrospective cohort study
Eculizumab
Length of Stay
Middle Aged
Intensive care unit
Hospitalization
Complement Inactivating Agents
Early Diagnosis
Multivariate Analysis
Plasmapheresis
Female
0305 other medical science
business
medicine.drug
Zdroj: Pharmacoeconomics
ISSN: 1179-2027
1170-7690
Popis: Background Atypical haemolytic uraemic syndrome (aHUS) is a rare, potentially life-threatening condition caused by dysregulation of the complement pathway. Eculizumab is currently the only approved treatment for this disorder. Objective Our objective was to investigate the impact of early administration of eculizumab on inpatient resource use and hospitalisation costs in 222 patients with aHUS. Methods We conducted a retrospective analysis of the Premier Perspective® Hospital Database, including patients with a diagnosis of aHUS and evidence of eculizumab use for aHUS. Early initiation was defined as having received eculizumab within 7 days of admission, with late initiation defined as starting eculizumab on day 8 or later. This date represents the average time required to obtain a specific diagnostic test to discriminate aHUS from a similar haemolytic syndrome that requires a different treatment. Outcome measures were time from first eculizumab initiation to discharge, discharge status or death, days spent in the intensive care unit (ICU), readmission indicators, dialysis indicators, and total hospital costs. Time from first eculizumab initiation to discharge was analysed using a generalised linear model with a log link and an assumed underlying negative binomial distribution. Logistic regression models were used to test the statistical significance of early versus late initiation as a predictor of the occurrence of readmissions, dialysis, and death. Total hospital costs were analysed using a generalised linear model with a log link and an assumed underlying gamma distribution. Results Before modelling, total length of stay and ICU duration were significantly longer for late initiators than for early initiators, and significantly more late initiators were readmitted within 90 days. Late initiation was associated with significantly higher hospital costs than early initiation. After multivariable analysis, late initiators were 3.2 times more likely to require dialysis. However, there was no significant association between early initiation and time to discharge, readmission, or death for any definition or early initiation after multivariable analysis. Estimated total hospital costs (year 2017 values) were $US103,557 in late initiators and $US85,776 in early initiators (p = 0.0024). Conclusion Initiation of eculizumab within 7 days of hospitalisation is associated with lower dialysis rates, less time in ICU, less plasmapheresis, and lower hospitalisation costs compared with late initiation. Electronic supplementary material The online version of this article (10.1007/s40273-019-00862-w) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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