The Delay and Costs of Diagnosing Systemic Vasculitis in a Tertiary-Level Clinic
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ORIGINAL RESEARCH
The Delay and Costs of Diagnosing Systemic Vasculitis in a Tertiary-Level Clinic Kirsi Taimen
. Anssi Mustonen . Laura Pirila¨
Received: October 29, 2020 / Accepted: November 28, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: The diagnosis of systemic vasculitis is a challenge because of the heterogeneity of clinical manifestations. The aim of this study is to analyze the diagnostic delay in systemic vasculitis, the total costs during the first year of care, and how the diagnostic delay affects the costs in a tertiary health care facility. Methods: Patients with a new diagnosis of systemic vasculitis between 2010 and 2018 were identified from hospital records. The diagnostic delay and health care costs were evaluated during the diagnostic period and within 12 months after the first contact with tertiary health care. Vasculitis-related costs were recorded as true costs charged. A total of 317 patients fulfilled the study criteria. The diagnoses were grouped into three clinically relevant groups: IgA vasculitis and other small-vessel vasculitis Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40744020-00266-9) contains supplementary material, which is available to authorized users. K. Taimen (&) A. Mustonen L. Pirila¨ Division of Medicine, Center for Rheumatology and Clinical Immunology, Turku University Hospital, Turku, Finland e-mail: [email protected] K. Taimen A. Mustonen L. Pirila¨ Department of Internal Medicine, University of Turku, Turku, Finland
(n = 64), ANCA-associated vasculitis (AAV) (n = 112), and large-vessel vasculitis (LVV) (n = 141). Results: The diagnostic delay from the first referral to tertiary-level clinic was shortest in the LVV group and longest in the AAV group. Total costs during the diagnostic period were the highest in the AAV group (median = €6754 [IQR €8812]) and lowest in the LVV group (median = €3123 [IQR €4517]), p \ 0.001. There was a significant positive correlation between the diagnostic delay and total costs during the diagnostic period and 12 months (rs = 0.38, p \ 0.001 and rs = 0.34, p \ 0.001, respectively). In a linear model, the inpatient days and the number of laboratory tests were the strongest predictors (p \ 0.001) of a higher treatment cost during the diagnostic period. Conclusions: There is a substantial diagnostic delay that correlates significantly with the costs in tertiary-level health care when diagnosing systemic vasculitis. Keywords: Cost of illness; Delay; Giant cell arteritis; Health care costs; Vasculitis
Rheumatol Ther
Key Summary Points Why carry out this study? The heterogeneous nature of systemic vasculitis presents a diagnostic challenge, which may delay early diagnosis and cause notable expense. Little is known about the diagnostic delay and economic burden of systemic vasculitis. What was learned from the study? This study analyzed the diagnostic delay in systemic vasculitides, their total cost during the first year, and how the diagnosis delay affects the costs. Ther
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