An Assessment of Infection Rates and Health Resource Use among Primary Immunodeficiency Disorder (pidd) Patients Prior to Diagnosis

RationaleIt is hypothesized that undiagnosed PIDD may burden both the patient with repeated infections and the healthcare system with significant service utilization. This analysis assessed infection rates and healthcare utilization among patients in the years leading up to a PIDD diagnosis.MethodsThis retrospective analysis utilized the Truven Marketscan Database, 2002-2012. Patients who had at least 1 inpatient or ER diagnosis or at least 2 outpatient diagnoses of PIDD (279.xx) and at least one of the following PIDD diagnoses: 279.04, 279.01, 279.05, or 279.06 and 5 years of continuous health plan enrollment were identified. The first PIDD diagnosis (279.xx) was identified as the index date and data preceding the index date were examined. Incidence rates of pneumonia, sinusitis, bronchitis, otitis, as well as hospitalizations, outpatient visits and outpatient drug utilization were analyzed.Results1388 patients were undiagnosed with PIDD for at least 5 years, of these, 84 were undiagnosed for at least 10 years, suggesting that many patients are undiagnosed for years. The average percent increase in rates of pneumonia, sinusitis, bronchitis and otitis per year over the 10 years prior to diagnosis were 39%, 20.4%, 20.2%, 14.2%, respectively. Hospitalizations, outpatient visits and outpatient drug utilization increased on average 29.1%, 10.5% and 5.3% per year, respectively during the same time frame. This considerable increase in infections and hospitalizations suggests the condition may be increasing in severity over time prior to diagnosis.ConclusionsThe results suggest a more timely diagnosis of PIDD may substantially ease the burden for both patients and the healthcare system. RationaleIt is hypothesized that undiagnosed PIDD may burden both the patient with repeated infections and the healthcare system with significant service utilization. This analysis assessed infection rates and healthcare utilization among patients in the years leading up to a PIDD diagnosis. It is hypothesized that undiagnosed PIDD may burden both the patient with repeated infections and the healthcare system with significant service utilization. This analysis assessed infection rates and healthcare utilization among patients in the years leading up to a PIDD diagnosis. MethodsThis retrospective analysis utilized the Truven Marketscan Database, 2002-2012. Patients who had at least 1 inpatient or ER diagnosis or at least 2 outpatient diagnoses of PIDD (279.xx) and at least one of the following PIDD diagnoses: 279.04, 279.01, 279.05, or 279.06 and 5 years of continuous health plan enrollment were identified. The first PIDD diagnosis (279.xx) was identified as the index date and data preceding the index date were examined. Incidence rates of pneumonia, sinusitis, bronchitis, otitis, as well as hospitalizations, outpatient visits and outpatient drug utilization were analyzed. This retrospective analysis utilized the Truven Marketscan Database, 2002-2012. Patients who had at least 1 inpatient or ER diagnosis or at least 2 outpatient diagnoses of PIDD (279.xx) and at least one of the following PIDD diagnoses: 279.04, 279.01, 279.05, or 279.06 and 5 years of continuous health plan enrollment were identified. The first PIDD diagnosis (279.xx) was identified as the index date and data preceding the index date were examined. Incidence rates of pneumonia, sinusitis, bronchitis, otitis, as well as hospitalizations, outpatient visits and outpatient drug utilization were analyzed. Results1388 patients were undiagnosed with PIDD for at least 5 years, of these, 84 were undiagnosed for at least 10 years, suggesting that many patients are undiagnosed for years. The average percent increase in rates of pneumonia, sinusitis, bronchitis and otitis per year over the 10 years prior to diagnosis were 39%, 20.4%, 20.2%, 14.2%, respectively. Hospitalizations, outpatient visits and outpatient drug utilization increased on average 29.1%, 10.5% and 5.3% per year, respectively during the same time frame. This considerable increase in infections and hospitalizations suggests the condition may be increasing in severity over time prior to diagnosis. 1388 patients were undiagnosed with PIDD for at least 5 years, of these, 84 were undiagnosed for at least 10 years, suggesting that many patients are undiagnosed for years. The average percent increase in rates of pneumonia, sinusitis, bronchitis and otitis per year over the 10 years prior to diagnosis were 39%, 20.4%, 20.2%, 14.2%, respectively. Hospitalizations, outpatient visits and outpatient drug utilization increased on average 29.1%, 10.5% and 5.3% per year, respectively during the same time frame. This considerable increase in infections and hospitalizations suggests the condition may be increasing in severity over time prior to diagnosis. ConclusionsThe results suggest a more timely diagnosis of PIDD may substantially ease the burden for both patients and the healthcare system. The results suggest a more timely diagnosis of PIDD may substantially ease the burden for both patients and the healthcare system.