From Daiichi Sankyo, Inc., Basking Ridge, NJ (Dr. Lin and Dr. Kwong); the Merative, Inc., Cambridge, MA (Wilson); Abraham Orthopaedics, Pennington, NJ (Dr. Abraham).
J Am Acad Orthop Surg Glob Res Rev. 2023 May 22;7(5). doi: 10.5435/JAAOSGlobal-D-23-00047. eCollection 2023 May 1.
Tenosynovial giant cell tumor (TGCT) may be misdiagnosed as osteoarthritis (OA), or the chronic course of TGCT may lead to development of secondary OA. However, little is known about the effect of comorbid OA on long-term surgical patterns and costs among TGCT patients.
This cohort study used claims data from the Merative MarketScan Research Databases. The study included adults diagnosed with TGCT from January 1, 2014, to June 30, 2019, who have at least 3 years of continuous enrollment before and after the first TGCT diagnosis (date of the first TGCT diagnosis = index date) and no other cancer diagnosis during the study period. Patients were stratified by the presence of an OA diagnosis relative to the index date. Outcomes included surgical procedure patterns, healthcare resource utilization, and costs in the 3-year pre- and postindex periods. Multivariable models were used to assess the effect of OA on the study outcomes, controlling for baseline characteristics.
The study included 2856 TGCT patients: 1153 (40%) had no OA before or after index (OA[-/-]), 207 (7%) had OA before index but not after (OA[+/-]), 644 (23%) had OA after index but not before (OA[-/+]), and 852 (30%) had OA before and after index (OA[+/+]). The mean age was 51.6 years, and 61.7% were female. During the postperiod, joint surgery was more common among OA(-/+) and OA(+/+) patients compared with OA(-/-) and OA(+/-) patients (55.7% vs 33.2%). The mean all-cause total costs in the 3-year postperiod were $19,476 per patient per year. Compared with OA(-/-) patients, OA(-/+) and OA(+/+) patients had a higher risk of undergoing recurrent surgery and higher total healthcare costs postindex.
Higher rates of surgery and increased healthcare cost observed in TGCT patients with postindex OA underscore the need for effective treatment options to reduce joint damage, especially among patients with comorbid OA.
腱鞘巨细胞瘤 (TGCT) 可能被误诊为骨关节炎 (OA)，或者 TGCT 的慢性病程可能导致继发性 OA 的发展。然而，对于 OA 并存对 TGCT 患者长期手术模式和成本的影响知之甚少。
本队列研究使用了 Merative MarketScan 研究数据库中的索赔数据。研究纳入了 2014 年 1 月 1 日至 2019 年 6 月 30 日期间被诊断为 TGCT 的成年人，他们在首次 TGCT 诊断前和诊断后至少有 3 年的连续参保（首次 TGCT 诊断日期=索引日期），并且在研究期间没有其他癌症诊断。根据 OA 相对于索引日期的诊断情况对患者进行分层。研究结果包括索引前和索引后 3 年的手术模式、医疗资源利用和成本。多变量模型用于评估 OA 对研究结果的影响，控制基线特征。
研究纳入了 2856 例 TGCT 患者：1153 例（40%）在索引前和索引后均无 OA（OA[-/-]），207 例（7%）在索引前有 OA 但在索引后没有（OA[+/-]），644 例（23%）在索引后有 OA 但在索引前没有（OA[-/+]），852 例（30%）在索引前和索引后均有 OA（OA[+/+]）。患者平均年龄为 51.6 岁，61.7%为女性。在随访期间，与 OA(-/-)和 OA(+/-)患者相比，OA(-/+)和 OA(+/)患者接受关节手术的比例更高（55.7%比 33.2%）。OA(-/-)患者的平均全因总成本为每年每名患者 19476 美元。与 OA(-/-)患者相比，OA(-/+)和 OA(+/)患者术后再次手术的风险更高，总医疗费用更高。
在 TGCT 患者中，OA 并存患者术后手术率较高，医疗成本增加，这表明需要有效的治疗方案来减少关节损伤，尤其是在合并 OA 的患者中。
