Gout Control Projected to Improve Patient Health and Reduce Costs

One in four patients with stage 3-5 chronic kidney disease (CKD) is affected by gout, an independent predictor for progression of CKD. Oral urate-lowering therapies do not adequately manage gout in some patients with CKD.

Brad A. Marder and colleagues conducted a study designed to examine the potential benefits of pegloticase treatment in patients with CKD with refractory gout. Results of the study were reported during a poster session at the American Society of Nephrology Kidney Week 2023 in a poster titled Projected Benefits of Gout Control on the Health and Economic Burden of CKD Patients With Uncontrolled Gout.

Gout burden in a virtual US CKD population was projected using a validated microsimulation model. In the baseline scenario, individuals were assigned an estimated glomerular filtration rate (eGFR), albuminuria status, and serum urate level. Those with gout were assigned complication risks for stroke, diabetes, and hypertension, as well as direct and indirect costs, use/efficacy of oral urate-lowering therapy probability (use, 29.2%-41.9% [based on eGFR]; efficacy, 48.3%), and utility weight.

In the intervention scenario, those with uncontrolled gout (defined as serum urate >6 mg/dL) despite oral urate-lowering therapy and two or more gout flares per year were “treated” with pegloticase, assuming a 71% serum urate-lowering efficacy rate (serum urate <6 mg/dL) through simulation end. Health and economic benefits were projected through 2035.

Results of the simulation suggested that the prevalence of comorbid gout and CKD would rise from 8.2 million in 2023 to 10.5 million in 2035; 28% of those patients would have uncontrolled gout. The annual costs of management of gout in patients with CKD were projected to increase from $39.1 billion in 2023 to $50.4 billion in 2035.

Use of pegloticase in all patients with CKD and uncontrolled gout was projected to result in 301,000 fewer cases of uncontrolled gout, a gain of 208,000 quality-adjusted life-years, and avoidance of 53,000 complications by 2035. Compared with the baseline scenario (nontreatment), the costs in the intervention scenario were $23.4 billion lower in 2035.

“Gout prevalence in CKD patients is projected to markedly increase over the next 12 years,” the researchers said. “This microsimulation suggests that intervention could result in health and quality of life improvement in CKD patients with uncontrolled gout, with associated cost reductions.”

Source: Marder BA, Card-Gowers J, Retat L, et al. Projected benefits of gout control on the health and economic burden of CKD patients with uncontrolled gout. FR-PO921. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 3, 2023; Philadelphia, Pennsylvania. Funding for this study was provided by Horizon Therapeutics plc.