Analisi degli outcome e del consumo di risorse sanitarie in pazienti con vasculite ANCA-associata in un contesto di pratica clinica in Italia [Analysis of outcomes and healthcare resource consumption in patients with ANCA-associated vasculitis in a setting of clinical practice in Italy]

Introduction. Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are the two most frequent forms of ANCA-associated vasculitis (AAV). The present analysis evaluated the demographic and clinical characteristics of affected patients, their therapeutic management with particular reference to glucocorticoids, outcomes, use of healthcare resources and related costs, in real Italian clinical practice. Materials and methods. A retrospective study was conducted on the administrative databases of Italian healthcare institutions, covering about 9 million health-assisted residents. From 2010 to 2020, adult patients with an exemption code for GPA and/or hospital discharge diagnosis for GPA or an exemption code for MPA with/without a discharge diagnosis for MPA were included. In the pre-inclusion period demographic and clinical data were collected (Charlson Comorbidity-Index-CCI), in the follow-up (1 year) glucocorticoid prescriptions and clinical outcomes (hospitalisations, onset of end-stage renal disease) were recorded. Annual consumption of healthcare resources (drugs, specialist outpatient services, hospitalisations), and related costs to the National Health Service (NHS) were estimated. Results. Of 738 AAV patients, 610 (82.7%) had GPA and 128 (17.3%) MPA. The gender distribution was comparable (except slight female prevalence in the MPA group), the mean age 57 years, regardless of disease form, and the comorbidity profile was worse in the GPA group (CCI=1.3) than in the MPA group (CCI=1.0). Glucocorticoid treatment was predictive of a 2.5-fold increased risk of hospitalisation/co-treatment. The outcome indicators confirmed the worse clinical presentation of GPA, which was associated with a higher rate of hospitalisations (GPA vs. MPA: 25.9 % vs. 8.6 %). Consistently, the analysis of consumption and costs showed in general that patients with GPA and those on glucocorticoid treatment required higher healthcare consumption and costs, mostly for ordinary and day-hospital admissions. Conclusions. AAV is associated with unfavourable outcomes, with GPA more frequent and associated with a worse clinical phenotype. The high utilisation of healthcare resources is mainly due to drug prescriptions and hospitalisations, and partly observed in patients treated with glucocorticoids.