Endocrine Abstracts

Objectives

There is a paucity of real-world studies analyzing comorbidities, lab testing and treatment patterns of patients with chronic hypoparathyroidism (cHP). This study describes a large cohort of cHP patients identified using a diagnosis-based approach from a US claims database.

Methods

This retrospective study was conducted using a large (130 million individuals) claims database (HealthVerity Closed Payer Claim Medical and Pharmacy databases: Private Source 20) from Oct 2014 to Dec 2019. Patients were eligible if they had ≥2 diagnosis claims of HP that were 6–15 months apart, a prescription claim for either active vitamin D, calcium, PTH or thyroid replacement therapy between the first HP claim and within 30 days of the second HP claim, and were continuously enrolled for one year before the index date (the date of the first of two qualifying HP diagnosis claims) and ≥16 months after. Patients were followed up to two years after the index date. Demographics, comorbidities, lab testing and treatment patterns were analyzed.

Results

Out of 43 640 patients with a diagnosis claim for HP, 4118 met the eligibility criteria. In this cohort, the mean age was 56.5 years + 18.6 (S.D.), and 76.4% were females, similar to data from other large cohort studies. The most common comorbidities during the 1-year follow-up were hypertension (56.0%), hypocalcemia (38.7%), cancer (30.5%, of which 24% were thyroid cancers), diabetes (29.4%), chronic pulmonary disease (24.1%), cardiac arrhythmias (17.4%), CKD stage 3–5 (17.0%), osteoporosis (9.6%) and neuropsychiatric disorders, including depressive disorders (22.0%), anxiety (21.6%), and sleep-wake disorders (18.4%). During the 1-year follow up, commonly ordered lab tests included serum calcium (89.9%), eGFR/creatinine (85.7%), 25-hydroxy vitamin D (61.1%), and intact PTH (43.9%). Serum phosphorous (36.3%), serum magnesium (35.4%) and 24 h-urine calcium (10.5%) were evaluated much less frequently. In addition, BMD was measured in 10.9% patients. During the same follow-up period, 67.1% of patients had a prescription claim for thyroid replacement therapy, 60.5% for calcitriol, 15.7% for ergocalciferol, and 3.4 % for PTH.

Conclusion

This study highlights the high comorbidity burden in cHP patients which is aligned with the observed monitoring patterns. Kidney health appears to be a key concern in this population, and may be an important consideration in therapeutic intervention. The comorbidities and practice patterns observed are consistent with the results found using a surgery-based approach to identify cHP patients within the same claims database. Future analyses will include the economic burden of cHP.