Use Of Central Venous Access Devices (CVAD) And Associated Outcomes In Hereditary Angioedema (HAE) Patients: Findings From A Large United States (US) Claims Database
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Douglas J. Watson, Marc A. Riedl, MD MS, Aleena Banerji, MD, Michael E. Manning, Earl Burrell, Namita Joshi, Dipen Patel, Thomas Machnig, Ming-Hui Tai
RATIONALE: Patients using intravenous C1-esterase-inhibitor (C1-INH) for routine prevention of Hereditary Angioedema (HAE) may have treatment difficulty due to vascular access issues; some patients require long-term CVAD placement for ongoing therapy. This observational study determined the prevalence of CVAD use and associated complications in United States (US) HAE patients using intravenous C1-INH in a real‑world setting.

METHODS: Retrospective cohort study using LifeLinkTM Health Plan database records between January 1, 2006 and December 31, 2014. Health care resource utilization (HCRU) data for patients with HAE and ≥1 claim for a HAE-specific medication were analyzed.

RESULTS: 18/434 (4.1%) patients treated with C1-INH(IV) (Cinryze® and/or Berinert®) had a CVAD placed. 10/18 (55.6%) experienced at least 1 CVAD-related complication, among whom there were 23 separate claims such as infections, mechanical complications, and complications not otherwise specified. 7/10 (70%) experienced ‘other complications’ due to other vascular device, implant, and graft. 5/18 (27.8%) patients with CVADs required hospitalization and 14/18 (77.8%) required an emergency department (ED) visit, compared with 79/521 (15.2%) and 271/521 (52.0%), respectively, among patients without a CVAD. The adjusted rate ratio of combined hospitalization and ED visits with a CVAD was 2.6 (95% CI: 0.17, 39.23; p-value: 0.492) compared with no CVAD.

CONCLUSIONS: The prevalence of CVAD use among US HAE patients receiving intravenous C1-INH therapy was found to be 4.1%. A majority of patients with CVADs had device-related complications. Hence, non-intravenous HAE prophylaxis options should be considered in HAE patients with vascular access failure due to the complication risk of a CVAD placement.