The Burden And Cost Of Illness Of Gout In Secondary Care In England

OBJECTIVES: Acute gout is one of the most painful forms of arthritis. Patients with gout frequently have multiple comorbidities including cardiovascular disease (CVD) and hyperuricaemia is an independent risk factor for CVD. In order to manage the underlying disease process, current British Society for Rheumatology guidelines recommend treat-to-target levels of serum uric acid. Suboptimal management of gout may place a substantial burden on secondary care services. The objective of this study was to evaluate the burden of gout on secondary care services in England. METHODS: Data captured in Hospital Episode Statistics (HES) for 2015/16 was analysed to estimate the number of patients with gout as a primary diagnosis who were managed in secondary care. Data included the number of interventions recorded for this patient cohort. Hospital Resource Group (HRG) tariff prices (2016/17) were used to calculate the associated costs of gout treatment. RESULTS: In total 6,443 patients were admitted with a primary diagnosis of gout, this group accounted for 6,992 spells of which 88% were unplanned non-elective admissions. The average unplanned length of stay was 6.5 days. The main HRGs to which these spells mapped were HD23A and HD23B. The cost of these unplanned spells on the NHS was £10,249,319 (ranging from £30,423 to £227,331 per CCG) with the average cost per patient dependent on the presence and severity of comorbidities. The main co-morbidities being hypertension (49%), atrial fibrillation (22%) and diabetes (21%). Eighty-nine percent of patients with gout in 2011 went on to be admitted for a CVD related primary admission by March 2017, resulting in a further burden on healthcare resources. CONCLUSIONS: Gout has a significant burden on hospital care in England. Targeting gout as a metabolic disorder, by treating hyperuricaemia as a risk factor for CVD, may lead to improved management of gout and reduced burden on secondary care services.