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Projected Health and Economic Burden of Comorbid Gout and Chronic Kidney Disease in a Virtual US Population: A
Joshua Card-Gowers1, Lise Retat1, Ada Kumar2
1HealthLumen Limited, 35 Ballards Lane, London, N3 1XW, UK.
Insights
Gout and chronic kidney disease (CKD) burden is rising in the US. Improved urate-lowering treatments can significantly reduce uncontrolled gout cases and associated healthcare costs.
Area of Science:
- Nephrology
- Rheumatology
- Health Economics
Background:
- Gout is a frequent comorbidity in chronic kidney disease (CKD) patients, leading to increased morbidity and healthcare use.
- A significant portion of gout cases remain undertreated, potentially worsening patient outcomes and escalating healthcare expenditures.
- This study quantifies the current and projected health and economic impact of managed and unmanaged gout within a US CKD population.
Purpose of the Study:
- To estimate the present and future health and economic burden of controlled and uncontrolled gout in a virtual United States (US) population with chronic kidney disease (CKD).
- To evaluate the potential benefits of urate-lowering interventions in mitigating the impact of gout in CKD patients.
Main Methods:
- A validated microsimulation model was employed to project the burden of gout in US CKD patients through 2035.
- A virtual CKD population was constructed using databases, categorizing individuals by controlled or uncontrolled gout status.
- The model assessed health and economic outcomes under a baseline scenario and simulated potential benefits from urate-lowering intervention strategies.
Main Results:
- The prevalence of gout co-occurring with CKD in the US is projected to rise by 29% from 7.9 million in 2023 to 9.6 million by 2035.
- Increases in gout flares, tophi, and comorbidities are expected, escalating the economic burden from $38.9 billion in 2023 to $47.3 billion in 2035.
- Enhanced use of urate-lowering therapies could decrease uncontrolled gout cases by 744,000 and pegloticase use by 353,000 by 2035, reducing complications and costs.
Conclusions:
- A substantial increase in the co-occurrence of gout and CKD is projected in the US.
- Optimizing the utilization of urate-lowering interventions presents a viable strategy to curb this growth and alleviate the health and economic consequences of gout in CKD patients.
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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