Pos0509 projecting the future health and economic burden of controlled and uncontrolled gout in the chronic kidney disease population in the us: preliminary results using microsimulation modelling methods

Background Chronic kidney disease (CKD) and gout are major public health concerns. The prevalence of gout (4%) and hyperuricemia (20%) is high in the general population and progressively increases as kidney function decreases [1,2] . An increasing number of people in the US are living with both gout and CKD, posing a significant health and quality of life (QoL) burden to patients while putting economic pressure on the healthcare system. Moreover, current gout management in the US is sub-optimal, with a large number of gout patients remaining untreated, undertreated, or uncontrolled [3] . Objectives To quantify the2023-2035 health and economic burden of controlled and uncontrolled gout in the US CKD population. Methods A validated microsimulation model was used to project gout burden in the US CKD population, which was reproduced virtually using United Nations data [4] . Each individual was assigned estimated glomerular filtration rate (eGFR), albuminuria, and serum urate (SU) values, which were extracted through analysis of the US NHANES (2011 to 2018). The prevalence of self-reported gout by age, sex, and CKD stage was also examined. Controlled and uncontrolled gout costs, eGFR decline rates, tophi and flare probabilities were drawn from the literature. Uncontrolled gout was defined as SU >6 mg/dL and ≥2 flares/yr or the presence of tophi. The microsimulation was run between2023 and 2035. Results The simulation predicts a 9.2% growth in the prevalence of gout and CKD in the US between2023 and 2035, from 7.6 million to 8.3 million patients, respectively. By 2035, 10.2% of CKD patients (5.5 million) are projected to have uncontrolled gout ( Graph 1 ), an annual average increase of 37,000 patients each year to 2035. This compares with 5.2% of CKD patients (2.8 million) with controlled gout by 2035. The number of people living with gout and advanced CKD (stages 3-5) is projected to grow by 19.4%, from 4.7 million patients in2023 to 5.8 million patients by 2035, of which the majority (67.2%) will have uncontrolled gout. Factors driving this increase are predominantly population growth and ageing. Tophi and flare occurrence are similarly projected to increase. The resulting combined direct and indirect costs of gout in CKD patients are projected to increase from $43.5 billion in2023 to $47.5 billion by 2035. This equates to a cumulative cost of $594.4 billion over the next 12 years, of which 76% is due to uncontrolled gout (Table 1 ). If all gout in CKD was controlled, the US could save $169.9 billion between2023 and 2035. Table 1. Annual costs of controlled and uncontrolled gout in CKD (2023 US$, Billions) Year Cost of controlled gout Cost of uncontrolled gout 2023 10.5 33.1 2029 11.1 34.8 2035 11.5 36.0 Cumulative (2023 – 2035) 143.7 450.7 Graph 1. Gout prevalence, by CKD stage (1, 2, and 3-5), in the US, between2023 and 2035 Conclusion In US CKD patients, gout prevalence and symptoms (tophi, flares) are projected to rise markedly between2023 and 2035, posing a substantial and increasing health, economic, and QoL burden. Uncontrolled gout is projected to contribute most to the health and economic burden of gout in CKD. Urate-lowering interventions may help reduce this burden by lowering the proportion of uncontrolled gout. Such measures would therefore reduce costs and healthcare utilisation while leading to QoL improvements in CKD patients with gout. References [1]Chen-Xu M, et al. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol 2019; 71(6): 991-9. [2]Krishnan E. Reduced glomerular function and prevalence of gout: NHANES 2009-10. PloS One 2012;7:e50046. [3]Edwards NL, et al. Management of gout in the United States: a claims-based analysis. ACR Open Rheumatol 2020;2:180-7. [4]Tangri N, et al. Projecting the epidemiological and economic impact of chronic kidney disease using patient-level microsimulation modelling: rationale and methods of inside CKD. Adv Ther 2022;1-17. Acknowledgements This research was supported by Horizon Therapeutics plc. Disclosure of Interests Joshua Card-Gowers Employee of: HealthLumen, Laura Webber Employee of: HealthLumen, Lise Retat Employee of: HealthLumen, Marek Piotrowski Employee of: HealthLumen, Brian LaMoreaux Shareholder of: Horizon, Employee of: Horizon, Brad Marder Shareholder of: Horizon, Employee of: Horizon, Ada Kumar Shareholder of: Horizon, Employee of: Horizon.