POS1386 REGIONAL DIFFERENCES IN PATIENT DIAGNOSIS JOURNEY AND HEALTHCARE UTILIZATION. RESULTS FROM THE INTERNATIONAL MAP OF AXIAL SPONDYLOARTHRITIS (IMAS)
Authors: M. Garrido-Cumbrera, D. Poddubnyy, F. Sommerfleck, C. Bundy, S. Makri, J. Correa-Fernández, S. M. Akerkar, J. Lowe, E. Karam, V. Navarro-Compán
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Both the diagnosis and management of axial spondyloarthritis (axSpA) can be challenging, requiring evaluation by a healthcare professional (HCP) in addition to clinical and laboratory tests. <h3>Objectives:</h3> The aim of this study is to assess differences in the journey of axSpA patients and access to healthcare around the world in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS). <h3>Methods:</h3> IMAS was a cross-sectional online survey (2017-2022) of 5,557 unselected axSpA patients from 27 countries. Across five worldwide geographic regions the 1) Patient journey: diagnostic delay (in years), healthcare professionals (HCPs) seen before diagnosis (GP, rheumatologist, orthopedic specialist, physiotherapist, osteopath and chiropractor), HCP that made diagnosis (GP, rheumatologist, orthopedic specialist and physiotherapist), and first test for diagnosis (MRI scan, x-rays, HLA-B27, ultrasound, radionuclide scintigraphy and CT scan) and 2) Healthcare utilization in the last 12 months prior to survey: healthcare visits (rheumatologist, GP, nurse, orthopedic specialist, physiotherapist, ophthalmologist or optician, pulmonologist, cardiologist, psychologist or psychiatrist, gastroenterologist and chiropractor), medical tests in the last 12 months (x-rays, MRI scan, ultrasound scan, radionuclide scintigraphy, CT scan, blood test and urine test), hospital admissions (in days), emergency visits (hospital, outpatient center, home emergency and ambulance) were analyzed. Total healthcare utilization was calculated as the sum of the number of healthcare visits, medical tests, hospital admissions and emergency visits based on the last 12 months prior to the survey. Univariable and multivariable linear regression was used to analyse possible associated factors with higher healthcare utilization. <h3>Results:</h3> Of 5,557 IMAS participants, 3,493 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America, and 146 from South Africa. The mean diagnostic delay was 7.4, needing more than two visits to HCPs for diagnosis (77.7% visited the GP and 51.3% the rheumatologist), and more than two diagnostic tests (67.5% performed HLA-B27, 64.2% x-rays and 59.1% MRI scans; Figure 1). In the previous 12 months, 94.9% (n = 5,272) used at least one healthcare resource, with the mean healthcare utilization at 29 uses per year. The countries with the highest healthcare utilization were Brazil, France, Spain, and Norway, with values above 30 uses. The countries with the lowest healthcare utilization were Costa Rica, the United Kingdom, India, and Slovenia, with less than 16. In the multiple linear regression, factors associated with higher number of healthcare utilization were younger age (b= -0.31), female gender (b= 7.74), higher disease activity (b= 1.46), poorer mental health (b= 0.62), greater functional limitation (b= 0.30), greater spinal stiffness (b= 1.53) and longer diagnostic delay (b= 0.10; Table 1). <h3>Conclusion:</h3> Patients with axSpA made more than two visits to HCPs and took at least 7 years to be diagnosed. After diagnosis, axSpA is associated with frequent healthcare resource use. Younger age, female gender, higher disease activity, poorer mental health, greater functional limitation, greater spinal stiffness, and longer diagnostic delay were associated with higher healthcare utilization. Europe and North America use more HCP visits and diagnostic tests before and after diagnosis than the other regions. Shortening the patient's journey to diagnosis, along with regular follow-up care and close collaboration between the patient and the medical team, are essential to effectively manage axSpA and improve the patient's long-term quality of life. Additionally, comprehensive country-level research is needed to assess the cost-effectiveness of axSpA management as well as its impact on health economics. <h3>REFERENCES:</h3> <b>NIL.</b> <b>Table 1.</b> Univariable and multivariable linear regression analysis of socio-demographic and patient-reported outcomes according to total healthcare utilization (N= 5,004) <h3>Acknowledgements:</h3> This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study. <h3>Disclosure of Interests:</h3> Marco Garrido-Cumbrera Novartis, Denis Poddubnyy AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, AbbVie, MSD, Novartis, Pfizer, Fernando Sommerfleck Abbvie, Eli Lilly, Janssen, Novartis, Abbvie, Novartis, Janssen, Christine Bundy: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer, Souzi Makri Novartis, GSK, Bayer, José Correa-Fernández: None declared, Shashank Murlidhar Akerkar Pfizer, Novartis, Eli Lilly, Jansen, Jo Lowe: No personal funding, but ASIF has received funding from Novartis, UCB, Lilly, Abbvie, Boehringer Ingleheim, Pfizer, Janssen, Elie Karam: None declared, Victoria Navarro-Compán AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Novartis.