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Sarcoidosis is a worldwide disease of unknown etiology. The disease is characterized by the finding of granulomas in the lung and other organs in the absence of any associated foreign material or pathogenic microorganisms (1). In prior studies, the total number of cases in the United States has been estimated to be between 150,000 and 200,000 people (2, 3). In the United States, the disease was found to be more common among African Americans than among white individuals (3, 4) and more common in women than in men (3, 5, 6). Early studies characterized sarcoidosis as a disease of young people, with most patients diagnosed before age 40 years (7). The onset of sarcoidosis was felt to be relatively uncommon in those over the age of 50 years (8). In more recent epidemiologic studies, researchers observed two peaks of incidence, one at ages 25–29 years and another at ages 65–69 years (9, 10). In recent epidemiologic studies, investigators found a shift in the peak incidence to ages 40–59 years in white individuals (11). In studies focused on American women, the incidence and prevalence were higher among African Americans than among white individuals, with increased rates in the Northeast (12, 13). However, since the mid-1990s, there has not been a systematic study of the epidemiology of sarcoidosis among all U.S. residents (3). The reported fractional rate of U.S. patients with sarcoidosis who require therapy has ranged from 10 to 80% (14–18). Referral centers often report a higher rate of treatment. The most commonly used treatment remains prednisone (16, 17). However, alternatives to prednisone are available (19). These include the antimetabolites methotrexate and azathioprine, as well as biologic agents such as the anti–tumor necrosis factor (TNF) monoclonal antibody infliximab (20). In 2013, Mitsubishi-Tanabe Pharma Development America contracted with OptumInsight to update and extend this information. OptumInsight is a business unit of Optum, which is the health services platform for UnitedHealth Group. OptumInsight provides software and information products, advisory consulting services, and business process outsourcing to participants in the health care industry. In preparation for compiling this report, OptumInsight staff members selected and assembled information from Optum’s closed U.S. managed health care database, which contains detailed information regarding a well-defined portion of the U.S. population. This database is derived from a deidentified patient database sourced from a large, nationwide commercial health insurance and Medicare parts C and D database. The data are continuously updated. The database includes information on patients’ complete history, demographics, drug use, and health care use over fixed time periods. Therefore, it allows a realistic estimation of the phenotypic expression and clinical course, as well as specific information regarding the incidence and prevalence of various conditions, across the entire U.S. population for individuals who had health care insurance between 2009 and 2013 (21–23)An analytical file of patients with sarcoidosis was created using Optum’s anonymized patient-level database, which represents approximately 32 million patients annually. We selected patients who filed medical claims between January 2009 and December 2013 with the 135.xx code of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Patients included in the cohort were 18 years of age or older and enrolled in a health plan within a large national health insurer affiliated with Optum. To exclude most patients for whom sarcoidosis was “ruled out,” we required subjects to have filed two or more medical claims at least 14 days apart using ICD-9- CM code 135.xx. Patient information collected included age, race, sex, and insurance type (commercial insurance plan vs. Medicare managed care plan). Treatment of sarcoidosis was captured from the database on the basis of information provided by health care providers treating patients diagnosed with sarcoidosis. Health care providers were encouraged but not required to indicate the condition for which any treatment was prescribed. The Optum database captures health care provider treatment decisions regarding sarcoidosis; however, the database does not indicate the specific motivation for treatment decisions made by health care providers. All patients seen between 2010 and 2013 were characterized for each 1-year period. Each unique case was identified during these 1-year periods as “new” if the patient had at least 12 months of preeligibility and no sarcoidosis diagnosed in the 3 years prior to that year. Patients were considered “continuing” if they had filed one or more claims for sarcoidosis in the 3 years prior to eligibility. Patients who had less than 12 months of preeligibility and no claims for sarcoidosis in the previous 3 years were considered “undefined.” Calculation of the incidence of sarcoidosis was based on the number of new cases seen in the year. Calculation of the prevalence of sarcoidosis was based on the total number of cases seen in the individual year (new, continuing, and undefined). The proportion of patients captured in the system was then extrapolated to the U.S. population, correcting for the age, race, and sex of the patients in the present study versus the corresponding U.S. census data. The sarcoidosis population, a subset of the Optum database, was segmented by patient type (new, continuing, or undefined). Once the patients were selected, Optum developed prevalence estimates for sarcoidosis by taking the patients with at least two medical claims for sarcoidosis during a calendar year and dividing that number by the total number of patients in the Optum database for that year. The available data were segmented by year, age, sex, race, line of business, and state. The data were projected to the U.S. population aged 18 years and older. The incidence rate was multiplied by the total U.S. population for each year to project the number of newly diagnosed patients. Similarly, the prevalence rate was multiplied by the total U.S. population for each year to project the total number of patients with sarcoidosis. For estimates of the U.S. population, we did not correct for socioeconomic differences between the Optum database and the U.S. population. The cost of care was determined using patients with both medical and pharmacy benefits. Cost-of-care categories included condition- and non–condition-related costs. We further segmented these two cost categories to better understand whether the cost of care was driven by treated or untreated patients with sarcoidosis. Across the treated and untreated groups, the individual cost categories were recorded. The cost was considered either related or not related to sarcoidosis on the basis of billing claims and was not further verified. We also gathered information about the cost per individual drug used to treat sarcoidosis. Comparisons were made by using chisquare tests where indicated. A P value less than 0.05 was considered significant. The age distribution of the sarcoidosis population is shown in Table 2. We also show the age distribution of the U.S. Optum members. Among the patients with sarcoidosis, 17,316 (59%) were 55 years of age or older, while only 14,200,000 (42.5%) of the U.S. Optum members were 55 years of age or older (chi-square = 1,688.769; P , 0.0001). The distribution of patients between 55 and 64 years of age was highest in both absolute percentage of patients with sarcoidosis and percentage of the Optum population in the same age group (31.2% vs. 15.0%). In contrast, the distribution of patients between 18 and 34 years of age was lowest in both absolute percentage of patients with sarcoidosis and percentage of the Optum population in the same age group (3.5% vs. 25.1%). Table 2 also shows the age distribution for new cases seen during the study period (6,831 unique patients).