High-Cost Sarcoidosis Patients in the United States: Patient Characteristics and Patterns of Health Care Resource Utilization

BACKGROUND: Sarcoidosis is a multisystem inflammatory disorder characterized by the presence of noncaseating granulomas in involved organs. Prior research has found that sarcoidosis imposes a significant economic burden to U.S. payers. However, the drivers of high health care costs among sarcoidosis patients are unknown. OBJECTIVE: To characterize sarcoidosis patients who were among the top 20% of total health care costs. METHODS: Patients with a first diagnosis of sarcoidosis between January 1, 1998, and March 31, 2015 (index date) were selected from a deidentified privately insured administrative claims database. Study patients must have at least 12 months of continuous health plan enrollment prior to the index date. High-cost patients were those in the top 20% of total health care costs during the 12 months following the index date (follow-up period), and the remaining patients were classified as lower-cost patients. Patient characteristics, comorbidities, health care resource use, and health care costs in the study period were compared between the high-cost and lower-cost patients. Multiple logistic regression was used to assess the relationship between patient characteristics and being a high-cost sarcoidosis patient. RESULTS: A total of 7,173 sarcoidosis patients met the selection criteria. The 20% of patients classified as high-cost patients accounted for approximately 72% of the total health care costs in the 12-month follow-up period. Compared with lower-cost patients, high-cost patients were slightly older (50.6 vs. 49.1 years) and had a higher comorbidity burden at baseline (Charlson Comorbidity Index = 1.8 vs. 0.7). Mean annual total health care cost for high-cost sarcoidosis patients was 10 times that of their lower-cost counterparts ($73,345 vs. $7,073). Mean annual health care cost was $119,878 for patients in the 95th-99th percentile and $375,436 for patients in the top 1% of spend. High-cost patients had greater medical resource use and costs across all places of service (i.e., inpatient, emergency department, outpatient, and other) compared with lower-cost patients. Findings showed that higher total health care cost resulted in a larger proportion of inpatient spend and a smaller proportion of outpatient and pharmacy spend. Adjusting for baseline characteristics, high-cost patients were associated with a number of factors with high ORs: the presence of comorbidities such as deficiency anemia (OR = 1.606; P < 0.001), depression (OR = 1.504; P < 0.001), or cardiac arrhythmia (OR = 1.493; P < 0.001); having an inpatient admission (OR = 9.771; P < 0.001); and use of biologic therapies adalimumab and/or infliximab (OR = 31.821; P < 0.001). CONCLUSIONS: This study described the characteristics of high-cost sarcoidosis patients and identified several high-cost indicators using contemporary administrative data. The health care cost distribution for sarcoidosis patients is highly skewed, making it a worthwhile endeavor to focus improvement efforts on patients in the top quintile. The study findings can help population health decision makers identify a subset of patients for targeted interventions aimed at improving quality of care and reducing overall costs. Copyright (C) 2017, Academy of Managed Care Pharmacy. All rights reserved.