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Healthcare resource utilization among patients with cold agglutinin disease in Denmark
Emese K Vágó1, Gina Nicholson2, Erzsébet Horváth-Puhó1
1Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
Insights
Patients with cold agglutinin disease (CAD) experience significantly higher healthcare resource utilization, including hospitalizations and transfusions, both before and after diagnosis. This highlights the need for earlier detection and management of this rare autoimmune hemolytic anemia.
Area of Science:
- Hematology
- Autoimmune Diseases
- Epidemiology
Background:
- Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia characterized by complement-mediated hemolysis, fatigue, and circulatory issues.
- Understanding healthcare resource utilization (HRU) in CAD is crucial for patient management and healthcare planning.
Purpose of the Study:
- To compare the HRU of patients with CAD to a matched non-CAD cohort using Danish national health registry data.
- To identify patterns of healthcare utilization before and after CAD diagnosis.
Main Methods:
- Retrospective cohort study using Danish National Patient Registry data (1999-2016).
- CAD cases were identified and matched to a general population cohort based on demographics and comorbidities.
- HRU, including hospitalizations, clinic visits, ER visits, transfusions, and medication use, was compared between cohorts.
Main Results:
- Patients with CAD had significantly higher odds of inpatient hospitalization (OR 3.9), outpatient visits (OR 17.2), and blood transfusions (OR 93.0) in the 12 months post-diagnosis.
- Elevated HRU was also observed in the 6 months preceding the index diagnosis date.
- Similar findings were noted in the primary CAD subcohort.
Conclusions:
- Patients with CAD incur substantial healthcare resource utilization in Denmark.
- Increased HRU predates CAD diagnosis, suggesting potential for earlier identification and intervention.
- This study provides the first characterization of HRU for European CAD patients.
Objectives:
Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia that may manifest in complement-mediated chronic hemolytic anemia, profound fatigue, and transient agglutination-mediated circulatory symptoms. This study compared the healthcare resource utilization (HRU) of patients with CAD with a matched non-CAD comparison cohort using national Danish health registry data.
Methods:
All cases of CAD were identified from 1 January 1999 to 30 June 2016, in the Danish National Patient Registry using the International Classification of Diseases, Tenth Revision, discharge diagnosis codes. A subcohort of patients with primary CAD was identified based on the absence of secondary predisposing concomitant diseases. CAD cases were matched to individuals without CAD from the general population based on birth year, sex, and 19 disease categories of the Charlson Comorbidity Index. Comparative analyses assessed inpatient hospitalizations, outpatient clinic visits, emergency room visits, transfusion use, and expensive drug use between cohorts 6 months before and 12 months after the admission date of the first hospital visit with CAD diagnosis (index date).
Results:
A total of 104 patients with CAD were matched to 1003 comparison cohort members. Throughout the 12 months after the index date, patients with CAD were more likely to have at least one inpatient hospitalization (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.5-6.0), outpatient clinic visit (OR, 17.2; 95% CI, 6.8-43.1), and blood transfusion (OR, 93.0; 95% CI, 33.3-259.8) than matched comparisons. HRU was similarly higher among patients with CAD than matched comparisons during the 6 months before the index date. Findings were similar among patients with primary CAD.
Conclusions:
Characterization of HRU among European patients with CAD has not previously been conducted. This study shows that patients with CAD utilize significant resources in Denmark. Increased HRU uses among patients with CAD before diagnosis presents opportunities for earlier diagnosis and management.
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