Endocrine Abstracts

Background

Chronic hypoparathyroidism (hypoPT) predisposes patients to comorbidities such as cardiovascular/cerebrovascular disease, infection, mental illness, and renal impairment often associated with an increased burden to healthcare systems. Suboptimal disease control is common with standard therapy. The objective of this study was to quantify and assess differences in the clinical and economic burden on secondary care among patients with post-surgical and non-surgical chronic hypoPT in England.

Methods

This multi-arm, retrospective cohort study was conducted using secondary care data collected between April 2014 and March 2019 by the Hospital Episode Statistics (HES) database records of patients with chronic hypoPT. Diagnosis of hypoPT was defined as the presence of ≥ 2 hypoPT ICD-10 codes reported ≥ 180 days apart. Patients with hypoPT must have had ≥ 1 HES interaction ≥ 360 days from the index date (inpatient, outpatient, or accident and emergency) to be included in this analysis. Data of patients with post-surgical and non-surgical chronic hypoPT were compared with those of patients with hypothyroidism and those who underwent thyroid surgery, respectively, for better understanding of clinical/economic burden against a broader patient population.

Results

The universal hypoPT cohort (n = 4.087) included data from post-surgical (n = 993) and non-surgical (n = 2.959) hypoPT patients and others (n = 135, defined as ICD-10 codes indicating both post-surgical and non-surgical hypoPT diagnoses). The prevalence of hypoPT and 1, 2 or 3 + comorbidities was consistently higher in non-surgical vs post-surgical hypoPT patients. Most comorbidities were significantly more frequent in non-surgical and post-surgical groups vs their respective comparators. The most common comorbidities included neuropsychiatric conditions (55.0% vs 55.1%; 55.2% vs 29.1%, P < 0001), renal insufficiencies (22.6% vs 12.9%; 35.4% vs 4.5%, P < 0.0001 both) and infections (25.3% vs 19.1%; 31.2% vs 7.4%, P < 0.0001 both). Healthcare resource utilization (HCRU) was higher in non-surgical and post-surgical hypoPT patients vs their respective comparator group (12.9 vs 6.5; 20.2 vs 2.4) in terms of longer mean spells per patient during inpatient visits and a lower proportion of outpatient appointments referred by a GP (17.8% vs 28.4%; 18.9% vs 41.6%). In the universal, post-surgical, and non-surgical cohorts, 0.2%, 0.5% and 0.1%, respectively, accrued annual inpatient and outpatient costs of > £60.000 per patient, mainly driven by renal comorbidities.

Conclusion

This study highlights the burden of disease, prevalence of comorbidities, and unmet medical needs in patients with hypoPT, as well as a high economic burden on the healthcare system in England by chronic hypoPT patients with a primary cost driver being renal complications across all cohorts.