The annual incremental cost of steroid-toxicity ranges from $6000 to $30,000 per patient depending on the dosage.[1]
Healthcare systems around the world are under pressure to deliver better patient outcomes. This poses a challenge that includes the constant change in available diagnostics and medications to serve patients along with the need to transform business and delivery models under resource pressures - all while meeting patients’ needs.
According to KPMG’s 2021 Healthcare CEO Future Pulse report, the vast majority of healthcare executives believe that all aspects of care delivery models will be transformed within the next three years, in an effort to prioritize quality over quantity of care through value-based or patient-centric healthcare environments.
Readmissions are a key measure of quality. How often patients are readmitted for the same problem or for adverse treatment events is a metric studied in both cost and care quality improvement circles. With that in mind, it’s worth noting that 1% of the adult population is on long-term glucocorticoid treatments [2]. They are widely used as an inexpensive and readily available treatment for a variety of conditions, even though long-term use is associated with a range of costly adverse events such as fractures, infections, gastrointestinal bleeding [1], and even death [3].
The annual incremental cost of steroid-toxicity ranges from $6000 to $30,000 depending on the dosage.[1]
According to Johns Hopkins lupus expert, Michelle Petri MD MPH, “There has to be an acceptance that steroids are now an undesirable part of treating most rheumatic diseases, and our prescribing behavior must change.”
In a previous interview, Dr Petri stressed that while there is a general understanding that glucocorticoids have toxic side effects, clinicians are busy trying to see so many critically ill patients in a short period of time that the side effects of a prednisone prescription are not always top-of-mind. “Physicians also know the steroids will work, and that it's easy to write a prescription because no insurance company ever challenges it and the patient can collect it the same day."
Steroids cost pennies a day, but over time, the costly damage they inflict on patient health are considerable. In 2009 USD, Sarnes et al estimate gastrointestinal complications alone could hit $30,000 (when inflation-adjusted to 2022 figures), and non-Hodgkin lymphoma to be $24,000 (in 2022 USD). [4]
Rheumatologist - ophthalmologist James T. Rosenbaum, MD opines that “Prednisone is in a sense a bit like a narcotic, it's easy to use, it's quick and handy, but you become dependent on it and in the long run, you suffer due to the dependency. For example, we know that steroid-toxicity leads to an increase in the propensity towards infection.”
“Steroid-toxicity is rampant, and it can be fatal… bringing it onto the radar screen of the practicing physician is really, really important.”
Dr Petri believes it is essential that we measure steroid-toxicity using a standard clinical outcome assessment such as the GTI so that steroid usage can be reduced. “Reducing steroids improves care and reduces costs…this would help insurance companies come on board because steroid use leading to chronic damage leads to a huge increase in care costs.”
To learn more about using the Steritas GTI in a point-of-care setting, click here.
References
[1] Rice JB, White AG, Scarpati LM, Wan G, Nelson WW. Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review. Clin Ther. 2017 Nov;39(11):2216-2229. doi: 10.1016/j.clinthera.2017.09.011. Epub 2017 Oct 19. PMID: 29055500.
[2] Laurence Fardet, MD, PhD, Irene Petersen, PhD, and Irwin Nazareth, MD, PhD Monitoring of Patients on Long-Term Glucocorticoid Therapy- A Population-Based Cohort Study. Medicine. Volume 94, Number 15, April 2015
[3] Einarsdottir MJ, Ekman P, Molin M, Trimpou P, Olsson DS, Johannsson G, Ragnarsson O. High Mortality Rate in Oral Glucocorticoid Users: A Population-Based Matched Cohort Study. Front Endocrinol (Lausanne). 2022 Jul 8;13:918356. doi: 10.3389/fendo.2022.918356. PMID: 35872995; PMCID: PMC9304700.
[4] Sarnes E., Crofford L., Watson M.et al.Incidence and US costs of corticosteroid-associated adverse events: a systematic literature review. Clin Ther. 2011; 33: 1413 PMID: 21999885 DOI:10.1016/j.clinthera.2011.09.009