Endocrine Abstracts

Introduction: Patients with Addison’s disease are burdened by substantial comorbidity and likely require a large package of care. There is a proportion of South African patients who can afford private health-care, comparable to health-care offered in a developed country. We hypothesised that comprehensive package of care costs for Addison’s disease is relatively high.

Methods: We identifed 131 patients with Addison’s disease within a private sector cohort, using ICD 10 code (E27.1). Demographic, co-morbidity and cost analysis data from claims were collected as of November 2015 (Rand/EURO=0.06), for the duration that the patients were members of a medical insurance company.

Results: The median (IQR) ages were 51 (37–67) in 2015 and commencement of membership 46 (33–62.5) years, respectively and membership duration 61.9 (36.4–103.5) months. There were 56% female patients, 75 and 100% received hydrocortisone and fludrocortisone, respectively. The most prevalent comorbidities were: hypothyroidism (34%), hypertension (32%), hyperlipidaemia (28%), gastro-oesophageal reflux disease (12%), congestive cardiac failure (8%), depression (8%), ischaemic heart disease (7%), and type 2 diabetes mellitus (6%). 15 and 7% of patients with Addison’s disease had at least one adrenal crisis and one admission for ischaemic heart disease, respectively within the study period, with median number of admissions per patient of 2 (1–4). From the perspective of the provider, mean overall and mean monthly overall direct costs for patients with Addison’s disease were €15 163.80 and €304.26, respectively. The mean comparable costs for patients with both hypertension and hyperlipidaemia were €10 911.47 and €181.50, and for AIDS patients on antiretroviral treatment (ART) were €10 643.93 and €236.00, respectively.

Conclusions: Substantial comorbidity, predisposition to adrenal crises, ischaemic heart disease contribute to the higher average package of care cost of Addison’s disease, compared to patients with both hypertension and hyperlipidaemia, and patients on ART.