Dubreuil Maureen, Magrey Marina, Haeffs Kathrin, Ivanov Evgueni, Gandrup Horan Julie
Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
Rheumatol Ther. 2025 Aug 29. doi: 10.1007/s40744-025-00791-5.
The journey to axial spondyloarthritis (axSpA) diagnosis is often prolonged, and delayed diagnosis has been associated with poorer outcomes and increased healthcare costs. This study aimed to characterize the patient diagnostic journey in axSpA and associated healthcare resource utilization (HCRU) and costs in the US.
This observational, retrospective US MarketScan study utilized insurance claims data from the Commercial/Medicare Supplemental (January 2008-March 2023) and Medicaid (January 2008-December 2022) databases to assess the time to diagnosis in adult patients with back pain onset prior to a new axSpA diagnosis. This study evaluated the time to axSpA diagnosis from the earliest back pain diagnosis, and the diagnostic journey through the number of consultations with healthcare professionals (HCPs) for back pain, diagnostic tests, and imaging procedures. Back pain-related HCRU and costs were assessed, as well as pharmacy claims during this period.
Of 97,469 patients included, 29.0% experienced time to diagnosis of ≥ 6 years, with a mean (standard deviation) of 4.5 (2.8) years to diagnosis. Prior to axSpA diagnosis, patients saw an average of 4.57 HCPs annually and had 20.7 back pain-related visits overall for back pain-related causes. Between the earliest back pain diagnosis and axSpA diagnosis, 55.9% of patients experienced > 10 back pain consultations, and patients underwent a range of diagnostic tests and imaging procedures. The median sum of non-capitated back pain-related costs up to axSpA diagnosis was $883.19 per patient per year, plus $1127.57 per patient per year for pharmacy prescriptions.
This study shows that diagnostic delay is a challenge for patients with axSpA in the US, despite numerous back pain consultations, specialist visits, and diagnostic tests. These findings highlight the urgent need for strategies to enhance recognition of axSpA and improve the patient diagnostic journey.
轴性脊柱关节炎（axSpA）的诊断过程往往漫长，而诊断延迟与较差的预后及医疗成本增加相关。本研究旨在描述美国axSpA患者的诊断过程以及相关的医疗资源利用（HCRU）和成本。
这项观察性、回顾性的美国市场扫描研究利用了商业/医疗保险补充数据库（2008年1月至2023年3月）和医疗补助数据库（2008年1月至2022年12月）中的保险理赔数据，以评估新发axSpA诊断前出现背痛的成年患者的诊断时间。本研究评估了从最早的背痛诊断到axSpA诊断的时间，以及通过与医疗专业人员（HCPs）就背痛、诊断测试和影像检查进行咨询的次数所经历的诊断过程。评估了与背痛相关的HCRU和成本，以及在此期间的药房理赔情况。
在纳入的97469名患者中，29.0%的患者诊断时间≥6年，平均（标准差）诊断时间为4.5（2.8）年。在axSpA诊断之前，患者每年平均看4.57名HCPs，因背痛相关原因总共进行了20.7次与背痛相关的就诊。从最早的背痛诊断到axSpA诊断之间，55.9%的患者经历了>10次背痛咨询，并且患者接受了一系列诊断测试和影像检查。在axSpA诊断之前，每位患者每年与背痛相关的非人头费成本中位数为883.19美元，加上每位患者每年用于药房处方的1127.57美元。
本研究表明，尽管进行了多次背痛咨询、专科就诊和诊断测试，但诊断延迟仍是美国axSpA患者面临的一个挑战。这些发现凸显了迫切需要采取策略来提高对axSpA的认识并改善患者的诊断过程。
