Uveitis: Dangerous and Costly

Atlanta—Uveitis (eye inflammation) poses a substantial economic burden, and associated costs increase with the number of uveitis-related medical visits. In patients who develop uveitis-related blindness, direct and indirect costs are estimated to be $3.58 billion annually. The condition is especially burdensome when uveitis is located in the intermediate/ posterior area of the eye (vs anterior disease) and for people who are blind. “Uveitis is common in several types of spondyloarthritis and is often overlooked in patients with arthritis. Yet it can lead to blindness and spiraling medical costs,” explained lead author Stephanie E. Kirbach, PhD, Abbott Laboratories, Abbott Park, Illinois, in a poster session at the ACR meeting. The poster was titled The Economic Burden of Uveitis. Rheumatologists and other physicians who treat rheumatologic diseases should be aware of the possibility of uveitis, the need for treatment, and the fact that it can lead to blindness, she added. In the majority of rheumatology patients, uveitis is idiopathic. Anterior uveitis often occurs as an extra-articular manifestation of rheumatologic conditions and has been documented in about one third of ankylosing spondylitis patients, one quarter of psoriatic arthritis patients, and about one third of all patients with spondyloarthritis. Uveitis can lead to vision loss and blindness in up to 35% of patients with spondyloarthritis. Posterior uveitis (inflammation of the choroids, retina, and optic nerve) and panuveitis (inflammation of the entire uvea) pose the greatest risk of vision loss and blindness, Dr. Kirbach stated. The study was based on the nationwide Thomson Reuters MarketScan® Database of health service claims data from approximately 100 third-party payers in the United States from 2000 to 2008. Claims for inpatient, outpatient, and emergency department care, and prescription drugs were analyzed; individual eligibility status and demographic information were included in the analysis. The focus of the study was 26,079 patients with noninfectious uveitis and >2 years of continuous enrollment before and after development of the first episode of uveitis. Overall, 22,356 of the patients had anterior uveitis and 3723 had intermediate uveitis, posterior uveitis, or panuveitis (IPP). At the index date, 209 patients with anterior uveitis and 86 patients with IPP were blind. After the index date, an additional 205 of those with anterior uveitis and 82 of those with IPP were blind. The average annual per-patient medical and drug cost for individuals with noninfectious uveitis was $8450 versus $4688 for controls without uveitis. Greater costs were documented in those with IPP than those with anterior uveitis: $12,149 versus $7834. Blind patients incurred greater costs than those who did not become blind: $17,846 versus $8236. Costs for patients who developed blindness during the study were $21,384, which is greater than that for patients who remained sighted ($8236) and for those who were blind at the start of the follow-up period ($14,404). Outpatient hospitalizations for uveitis accounted for 29% of all costs, and drugs accounted for 22% of all costs. Costs were increased with the number of medical visits for uveitis, particularly for ≥3 visits. The highest costs were found in blind patients with IPP and >3 outpatient visits ($50,207), according to the researchers.