OBJECTIVES: Classic CAH is a rare condition characterized by cortisol deficiency and androgen excess, typically requiring treatment with supraphysiologic doses of glucocorticoids. This study evaluated the costs and identified key cost drivers for classic CAH in the United States (US).

METHODS: Real-world administrative claims data from IBM MarketScan Research Databases, with de-identified data of >200 million patients in the US between Jan 2006 and Dec 2020, was retrospectively analyzed for cost of care. The CAH cohort for analysis included patients with ICD codes (255.2, E25.0, or E25.9) and with either of the two glucocorticoid sensitivities (60% proportion of days covered or five glucocorticoid prescriptions). Patients were stratified into low, medium, and high-cost groups as per equal cumulative costs distribution in a 4-year period (±2 years from index date). Costs were calculated by patient segment, demographics, facility, diagnoses, procedures, and drugs.

RESULTS: The study included 7,150 patients with classic CAH (41.8% pediatric, 58.2% adults, 40% female) ages <1-90 years. High-cost patients (per member per year (PMPY) costs $81,020; n=209) accounted for 2.9% of classic CAH patients, 12% were medium-cost (PMPY=$22,012; n=855), and 85% were low-cost patients (PMPY=$5,822; n=6,073). High-cost patients of all ages were more likely to visit the emergency department (94%, vs. 82% medium-cost and 55% low-cost patients). In addition, 89% of high-cost patients had inpatient stays compared to 67% medium and 25% low-cost patients. High-cost patients were more likely to have fatigue/malaise (64%) compared to medium-cost (45%) and low-cost (21%) patients. Roughly 15% of patients (high and medium-cost cohorts; n=1,064) accounted for two thirds of the total costs paid to the providers.

CONCLUSIONS: Key cost drivers in the care of CAH patients include inpatient hospitalizations, ancillary services, and diagnostic procedures. Current and emerging therapies for CAH should be evaluated for their potential to impact these cost drivers.