Posters Show TED Associated With High HRU and Low QOL

Patients with thyroid eye disease (TED) have high rates of health care resource utilization (HRU) and their disease has substantial impact on their quality of life (QOL).

Thyroid eye disease (TED) can be sight-threatening, disfiguring, and debilitating, and patients experience a significant decline in their quality of life (QOL) and impact on daily life. Two posters presented at the American Academy of Ophthalmology 2021 conference evaluated all-cause health care resource utilization (HRU) for patients with TED treated with steroids and/or eye surgeries and identified health state utility (HSU) values associated with 6 health states in moderate to severe TED. Up to 35% of patients with TED experience moderate to severe disease.

In the first poster, the researchers used a retrospective cohort analysis.1 The data included were from the IBM MarketScan database, 2012-2018. There were 1601 patients with moderate to severe TED and 77% were female. The mean age was 54 years. Most (79.9%) had at least 1 claim for an oral steroid, 40.5% had at least 1 claim for TED surgery, and 35.8% had at least 1 claim for an intravenous steroid.

There were a total of 2597 surgeries performed for the 645 patients who had at least 1 TED-related surgery. The mean number of eye surgeries was 4.03. One-fourth (25.5%) had orbital decompression, 18.20% had eyelid reconstruction, 11.8% had strabismus surgery, and 14.2% had other eye surgery.

Among the total patient population, nearly all (99.8%) had at least 1 outpatient visit during the postindex period, 24.6% had an inpatient visit, 40.7% had emergency department visits, and 86.9% received prescriptions.

The researchers found:

  • The annualized all-cause HRU was 27.15 visits among patients with TED
  • 99.8% had at least 1 outpatient visit
  • 24.6% had at least 1 inpatient visit
  • 86.9% received prescriptions
  • 40.7% experienced at least 1 emergency department visit

“Compared with other chronic disease studies of HRU assessments, patients with TED generally exhibited higher all-cause HRU for inpatient and outpatient visits,” according to the researchers.

The findings show a significant overall economic burden of TED HRU and a need for more research to capture the downstream complications and quality of life impact.

In the second poster, the researchers described and validated 6 health states to identify the HSU values associated with the states using 2 placebo-controlled trials of teprotumumab.2 The patients included in the study had moderate to severe TED that had started within the past 9 months. They had a clinical activity score (CAS) of at least 4.

The authors pilot tested their health state descriptions in time trade-off (TTO) interviews first with 10 people from the general US population followed by TTO interviews of 101 people. None of the 111 people interviewed had TED.

The participants chose between living with a health state for 10 years followed by death or living for a shorter amount of time in full health followed by death and they had to rate health states using a visual analogue scale with 0 being death and 100 being full health.

The overall mean (SD) HSU value for TED was 0.44 (0.34), which indicates a lower/worse QOL than mean values for leukemia (0.77) or glaucoma (0.81). Other TED values were:

  1. 0.60 for no diplopia and less than 3 mm proptosis
  2. 0.46 for no diplopia and at least 3 mm proptosis
  3. 0.52 for intermittent/inconstant diplopia and less than 3 mm proptosis
  4. 0.43 for intermittent/inconstant diplopia and at least 3 mm proptosis
  5. 0.34 for constant diplopia and less than 3 mm proptosis
  6. 0.30 for constant diplopia and at least 3 mm proptosis

The value for constant diplopia and at least 3 mm proptosis was almost as low as that for blindness with no light perception (0.26).

“To the best of our knowledge, this is the first study to fully assess HSU values for active, moderate-to-severe TED, but this mirrors the QOL self-reported data in the literature,” the authors wrote. “These data provide a baseline for future assessment of QOL gains attained with TED treatments.”


1. Kossler AL, Batten R, Cameron C, et al. Thyroid eye disease and healthcare resource utilization. Presented at: American Academy of Ophthalmology 2021; November 12-15, 2021; New Orleans, LA. Poster PO028.

2. Cockerham K, Taylor SD, Barretto N, Enstone A, Oliver L, Jolt RJ. Development of health state utilities for thyroid eye disease (TED). Presented at: American Academy of Ophthalmology 2021; November 12-15, 2021; New Orleans, LA. Poster PO295.