This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Aim: Patients with classic Congenital Adrenal Hyperplasia (CAH) have poor health
outcomes. In the absence of a comprehensive observational study, this manuscript provides a
model to estimate the lifetime disease burden of adults with classic CAH.
Methods: The model, built in Excel, comprises sub-domains addressing the health
consequences of CAH, and synthesises evidence from clinical and epidemiological studies on
health outcomes.
Results: The model estimates that adults with classic CAH will implement “sick day rules”
(doubling or tripling glucocorticoid and/or use of parenteral therapy) 171 times over their
lifetime, and attend hospital for adrenal crisis on 11 occasions. In a population of 1,000, over
200 will die of a condition complicated by adrenal crisis resulting, on average, in a loss of 7
years of life. CAH patients may also suffer from excess CVD events. Treatment with
glucocorticoids almost doubles the risk of bone fractures in CAH patients compared to the
general population, leading on average to an additional 0.8 fractures per CAH patient over
their lifetime.
Conclusions: The disease burden model highlights gaps in evidence, particularly regarding
intensity of care and adrenal crisis, and the relationship between control of CAH and risks of
CVD, osteoporosis, diabetes and infertility. The model can be used for research on the impact
of new clinical pathways and therapeutic interventions in terms of clinical events and cost.Funded by: European Commission under the Framework 7 programme. Grant Number: HEALTH-F5-2011-281654Diurnal Limited (UK
