POSC186 Higher Rates of Complications and Health-Care Resource Utilisation in Achondroplasia Compared to the General Population: A Matched Cohort Study Using the Cprd-HES Database

Achondroplasia (ACH) is a rare skeletal dysplasia condition, resulting in disproportionate short stature and multiple complications. We aimed to estimate disease burden and health-care resource use (HCRU) in ACH patients compared to general population controls. A matched retrospective cohort study was conducted using the Clinical Practice Research Datalink (CPRD-GOLD) linked to Hospital Episode Statistics (HES) in England. A cohort of ACH patients (study index date first record of ACH between 01/01/1987-31/12/2018) were index date matched (1:4) by age, sex, general practitioner (practice level) and linkage ability to HES to control patients, defined as those with no evidence of skeletal/growth disorders. Event rates per 100 person-year were calculated for a pre-defined set of complications, medical imaging (skeletal x-rays, DEXA scans etc), in-patient surgeries and HRCU by age-group; rate ratios (RR) with 95% CIs were used to compare between cohorts. We identified 275 ACH cases and 1,064 matched controls; 51% female, median age 28 years (IQR 7-40 years). Considering all pre-defined complications, complications were twice as likely to be reported among ACH patients than controls (RR = 1.98 [1.89-2.08], ranging from RR=1.13 [1.00-1.28] for cardiovascular conditions to RR=8.31 [4.72-14.61] for developmental issues. Furthermore, significantly higher rates of medical imaging (RR=2.48 [2.31-2.65]) and in-patient surgeries (RR 9.80 [7.84-12.26]) comprising mainly of ear/nose/throat and orthopaedic procedures, were reported among ACH patients. ACH patients reported significantly more HCRU than controls; GP visits RR=1.53 [1.52-1.55], hospital out-patient RR=2.44 [2.38-2.50] and in-patient visits RR=2.18 [2.06-2.30]. Complications and HCRU were highest among youngest (≤10y) and oldest (≥60y) age-groups. In a real-world clinical setting, ACH patients experience significantly higher rates of complications, medical imaging, surgeries and healthcare resource use compared to an appropriate matched general population cohort, consistently throughout life. These findings may have impact for proactive clinical management and patient care.