SAT233 Clinical And Economic Burden Of Postsurgical Chronic Hypoparathyroidism: A US Medicare Retrospective Analysis
Authors: Noori Wahidullah , Inguva Sushmitha , Sibley Christopher T , Chirikov Viktor , Smith Alden R 
Published: October 2023

Abstract
Disclosure: W. Noori: Employee; Self; Ascendis Pharma, Inc. S. Inguva: Employee; Self; OPEN Health. Other; Self; Research Funding (institution): Ascendis. C.T. Sibley: Employee; Self; Ascendis Pharma, Inc. V. Chirikov: Employee; Self; OPEN Health. Stock Owner; Self; OPEN Health. Other; Self; Research Funding (institution): Ascendis. A.R. Smith: Employee; Self; Ascendis Pharma, Inc.
Background: Hypoparathyroidism is a rare endocrine disease characterized by insufficient parathyroid hormone (PTH) production and is associated with substantial burden of illness. Individuals with hypoparathyroidism often report physical, emotional, and cognitive symptoms indicating impaired health-related quality of life (HRQoL). Objective: To describe demographics, clinical characteristics, healthcare resource utilization (HCRU), and costs among individuals with postsurgical chronic hypoparathyroidism compared to individuals without hypoparathyroidism in Medicare Fee-For-Service (FFS). Methods: Adults with newly diagnosed postsurgical chronic hypoparathyroidism were identified from the Medicare 100% Limited Data Set between July 1, 2017, to March 31, 2020. All had a confirmed diagnosis within 6-12 months after index diagnosis. Individuals were required to be continuously enrolled for ≥6 months pre- and ≥12 months post-index for baseline and follow-up assessments. Those with a prior hypoparathyroidism diagnosis in the baseline period were excluded. A random sample of enrollees without hypoparathyroidism was synthetically assigned an index date of diagnosis to ensure similar baseline and follow-up periods as individuals with postsurgical chronic hypoparathyroidism. Baseline demographics and comorbidities were compared descriptively. All-cause HCRU and costs during baseline and follow-up were evaluated. All costs were inflated to 2021 US dollars. Results: Individuals with postsurgical chronic hypoparathyroidism (N=1,166) were older than those without hypoparathyroidism (N=11,258) (median age of 69 vs 64 years) and more were female (76% vs 57%); they also had higher Charlson Comorbidity Index scores at baseline (3.24 vs 0.73) and a higher prevalence of moderate or severe renal disease (28.8% vs 5.6%), nephrolithiasis (8.3% vs 1.0%), urinary tract infections (9.9% vs 2.2%), hospitalizations for infections (11.9% vs 2.5%), congestive heart failure (13.1% vs 3.0%), among others. Over a median follow-up of 30 months, mean [SD] all-cause medical costs per patient per year (PPPY) were significantly higher among individuals with postsurgical chronic hypoparathyroidism ($199,297 [$443,294] vs $61,897 [$210,825]). This difference was largely attributable to higher all-cause medical utilization among individuals with postsurgical chronic hypoparathyroidism (22.0 vs 11.6 inpatient days PPPY; 15.3 vs 5.8 outpatient visits PPPY). Individuals with postsurgical chronic hypoparathyroidism also had higher mortality compared to those without hypoparathyroidism (HR=2.75 (95% CI: 2.15-3.51). Conclusions: The clinical and economic burden of individuals with postsurgical chronic hypoparathyroidism in Medicare FFS is substantial, highlighting the need for innovative treatment options to replace the missing PTH hormone.
Presentation: Saturday, June 17, 2023