OBJECTIVES

Cold agglutinin disease (CAD) is a rare subtype of autoimmune hemolytic anemia that is seen in a middle-age and elderly population. There are no currently approved treatments and the impact of healthcare resource utilization (HRU) in these patients has not been evaluated. The objective of this study was to better define HRU in CAD.

METHODS

CAD patients were identified from 2006-2016 in the Optum-Humedica database by a method that incorporated mentions of CAD terms in clinical notes and hematologist review. Patients were required to have records in Integrated Delivery Network and ≥6 months’ follow-up before and after index date (defined as first mention of CAD in clinical notes). Patients were matched to comparisons on gender, age, region of residence, race, year of entry, follow-up time, and Charlson Comorbidity score. Multivariate analyses assessed inpatient, outpatient and emergency room use.

RESULTS

Of the 814 identified CAD patients, 410 had complete HRU information and were included in this analysis and matched to 3396 comparisons. 70% of the cohort was over 65 years of age and approximately 60% was female. In the 6 months prior to index date, the mean numbers of inpatient hospitalizations (0.34 vs. 0.10), outpatient visits (6.40 vs. 2.98), and emergency room visits (0.25 vs. 0.12) were significantly higher among CAD patients than matched comparisons (p<0.0001 for each). In the 12 months after index date, CAD patients continued to have significantly higher HRU than comparisons for these same services (p<0.0001 for each).

CONCLUSIONS

As all HRU measures evaluated were increased in the CAD group, our results suggest that CAD places a substantial burden on patients and healthcare systems. In addition, the fact that HRU was also increased 6 months prior to diagnosis indicates that disease awareness and better diagnostic practices are needed.