Practice Update: Conference Series - EULAR Congress 2017

Failure to prescribe urate-lowering treatment exacerbates hospitalisation for gout Hospitalisation for gout has risen over the last decade, with a resultant increase in healthcare costs, in a major region of Sweden. Many patients admitted to hospital had not been receiving the recommended urate-lowering treatment, finds a population-based registry study.

M ats Dehlin, MD, of the Sahlgrenska Academy at the University of Gothenburg, Sweden, explained that gout is the most common arthritic disease in the world, and inci- dence and prevalence are increasing. An increase in hospitalization for gout has been shown over the last two decades in North America. “It is important to collect these data from different parts of the world as gout prevalence will vary as well as the course of the disease, due to cultural, ethnic and genetic factors,” Dr Dehlin said. Dr Dehlin and colleagues set out to assess hospitalization trends for gout using data from the healthcare consumption register from 2001 through 2012 in the Western Swedish Health Care Region, an area of the country believed to repre- sent the whole of Sweden. Patients aged 18 years and older who were hospitalized during the study period with a principal ICD-10 diagnosis of gout at discharge were included. Dr Dehlin and coinvestigators calculated annual population rates for hospitalization for gout. Inflation-adjusted healthcare costs for gout hospitalizations were calculated using the Cost- Per-Patient register. Dispensation of urate-lowering therapy, including allopurinol and probenecid, was identified using the Swedish Prescribed Drug Register within 6 months prior to hospitalization. A total of 1873 hospitalizations for gout were recorded (mean patient age 75.0–77.6 years, 61–74% men) between 2000 and 2012.

Demographic characteristics were similar over the study period. From 2000 to 2012, the annual hospitalization rate for gout in western Sweden increased from 12.2 to 16.7 per 100,000 adults (P = 0.0038). This rise was most pronounced over the last 3 years of the study in males aged 65 years and older. In addition, the length of hospitalization increased from a median of 3 to 5 days in 2000 and 2012, respectively (P = 0.021). The increase was exac- erbated by widespread failure to treat. The findings are in marked contrast to the over- all trend in hospitalization across the Western Swedish Health Care Region. Over the same decade, the number of days of inpatient care due to physical conditions in the region decreased by 9% from 2002 to 2012 (1,267,900 days, mean duration 5.7 vs 1,151,630 days, mean duration 4.9 days, respectively). From 2009 to 2012, inflation-adjusted healthcare costs for gout hospitalization increased from $521,000 to $815,000. Only a minority of patients, 19% to 27%, received urate-lowering therapy in the 6 months preceding hospitalisation, with no obvious cyclical or seasonal trend. Dr Dehlin concluded, “The incidence of hospitaliza- tion for primary gout has increased substantially in Sweden over the last decade, and this is reflected in associated healthcare costs. Though we would expect more hospitalizations due to the increasing incidence of gout among an aging population, the

Dr Mats Dehlin

PRACTICEUPDATE CONFERENCE SERIES • EULAR CONGRESS 2017 4