Severe Thyroid Eye Disease in the US: A National Perspective

Abstract Background: Thyroid eye disease (TED) is an unpredictable autoimmune inflammatory which can be sight-threatening, debilitating, and disfiguring. The majority of patients have mild, self-limited TED, 20-30% experience moderate/severe disease, 3-5% may develop sight-threatening such as CON or exposure keratopathy. Surgical intervention commonly necessary for with stable however, there little data on the prevalence TED requiring surgical interventions. Objective: To document number procedures thyroid in US evaluate associated costs these Methods: National Ambulatory Surgery Sample (NASS) largest ambulatory surgery database, representing approximately 14 million surgeries performed annually a hospital setting US. Data from 2,699 hospital-owned facilities located 31 States District Columbia, approximating 63-percent stratified sample U.S. performing selected are available analyses. clinical diagnoses, disposition patient, expected source payment, total charges, well geographic, facility, patient characteristics collected. For purposes this study, was identified by concomitantly occurring ICD 10 codes ICD-10 manifestations disease. CPT were used to identify patients. coding algorithms developed consensus three ophthalmic surgeons. Results: In 2018, 1,991 required surgery, national 0.6 per 100,000 population. Mean age at 56.2 years (95% Confidence Interval (CI) 55.3-57.2). Women comprised 73% (1455 women 536 men) who underwent surgery. average charges each encounter $21,875 CI $19,066-$24,684). Total totaled over 43.5 annually. While many had private insurance (49.7%), Medicare (31%) Medicaid (13%) also significant sources reimbursement. Of all TED-related surgeries, 93% conducted teaching hospitals. Only 0.2% non-urban rural settings. Conclusion: US, severe although uncommon, has economic impact. Further research warranted better understand natural history that inform treatment pathways prevent complications needing