Abstract
Purpose :
To characterize variation in the treatment of patients with thyroid eye disease (TED) and characterize geographic variation in treatment patterns using a retrospective claims-based analysis.
Methods :
A nationally representative claims based database was used identify 2,983 patients from 2008-2016 with TED using ICD codes for Grave’s disease or thyroid dysfunction and sequelae of TED such as lid retraction or proptosis. We included patients with continuous enrollment for at least one year before and after diagnosis of TED and excluded patients with any prior TED surgery. We determined the type, number, and order of therapeutic medications, interventions and rehabilitative procedures received by each patient using CPT codes and generic names.
Results :
The majority of patients (81.1%) were women with a mean age of 48.0 (standard deviation (SD): 11.1). The most common first line of medical treatment for patients was glucocorticoid therapy (76.3%) followed by surgical intervention (12.1%). Of glucocorticoids, the most common medications were oral prednisone (44.0%) and intravenous or intramuscular methylprednisolone (22.9%). Of first line surgical interventions, transcutaneous/transconjunctival orbital decompression (35.6%) and eyelid surgery (28.2%) and were the most common. When accounting for all treatments, glucocorticoids were used to treat 55.7% of patients, 29.9% underwent surgical intervention, 12.7% received other medications such as immunotherapy, and 2% underwent radiotherapy. Across all medical treatments, glucocorticoid use was significantly lower in the West (51.2%) when compared with the Northeast (58.4%) and the South (57.0%), p=0.003). Surgical intervention was least common in the Northeast (26.6%) and significantly lower than rates in the Midwest (31.1%) and West (31.9%) (p=0.007). Rates of radiation did not differ significantly by region as a first-line therapy or as any treatment in TED patient pathways.
Conclusions :
In terms of both initial and overall treatment patterns, this study found modest variation in rates of medical and surgical management of TED. While glucocorticoids are primarily first line therapy, there are differences in regions for first line medical management of TED. Future studies will account for variation by patient-level and physician-level factors.
This is a 2020 ARVO Annual Meeting abstract.