A0192 - Health Care Resource Utilization and Costs Among Eosinophilic Esophagitis Patients in the United States

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Eilish McCann, PhD

Regeneron Pharmaceuticals
Tarrytown, NY

Award: Presidential Poster Award

Mirna Chehade, MD, MPH¹, Andrew J. Epstein, PhD², Eilish McCann, PhD³, Sarette T. Tilton, BSc, PharmD⁴, Arpita Nag, MBA, MS, PhD⁵, Chao Chen, BSc, PhD³, Degang Wang, BSc, PhD³, Tiffany Pela, MPH, PharmD⁵, Angela Khodzhayev, PharmD³, Ryan Thomas, PharmD, MS⁶
¹Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, NY; ²Medicus Economics, Milton, MA; ³Regeneron Pharmaceuticals, Tarrytown, NY; ⁴Sanofi, Cambridge, MA; ⁵Sanofi, Bridgewater, NJ; ⁶Regeneron Pharmaceuticals, Montclair, NJ

Introduction: Eosinophilic esophagitis (EoE) is a chronic, progressive type 2 inflammatory disease which negatively affects quality of life. The economic burden of EoE is unclear. We aimed to describe the healthcare resource utilization (HCRU) and economic burden of EoE in the US.

Methods: In this retrospective cohort analysis of claims data from the IQVIA PharmMetrics Plus database (Jan 1, 2017–Jun 30, 2020), patients with ≥1 EoE diagnosis (ICD-10 code K20.0) between Jan 1, 2018–Jun 30, 2019 were compared with non-EoE controls. Index was a randomly selected claim with an EoE diagnosis code (for patients with EoE) or random date (for controls) within the identification window. Included patients required 365 days of pre-index baseline data, and 365 days of follow-up. Patients were 1:1 matched for age, sex, insurance, and geographic region. Per patient HCRU and costs during follow-up were reported and compared by Wilcoxon signed-rank tests. Adjusted HCRU and costs were determined via regression adjusting for non-EoE-related comorbidities. A subanalysis assessed patients who received dilation for EoE during baseline.

Results: In total, 15,432 patients with EoE and 15,432 matched controls were included (mean age: 36.2 years; male: 62.8%). During baseline, considerable proportions of patients with EoE received swallowed topical corticosteroids (29.6%), proton pump inhibitors (63.7%) or esophageal dilation (21.4%). Unadjusted HCRU burden and costs were consistently higher for EoE cases (Table). When adjusting for non-EoE related comorbidities, HCRU and costs were significantly higher in patients with EoE compared with controls, especially prescription use (mean: 20.6 vs 11.6 fills), outpatient visits (mean: 15.3 vs 8.4 days), days with emergency room (ER) visits (mean: 0.5 vs 0.2 days) and total healthcare costs ($15,354 vs $7,262). Inpatient visits, days with inpatient visits and inpatient costs were not significantly different between patients with EoE and non-EoE controls. EoE patients with baseline dilations (n=3,310) had high total costs ($16,964) and frequently experienced days with ER visits (1.1 days).

Discussion: Annual HCRU and costs were higher in patient with EoE versus matched controls, particularly for prescription use, outpatient visits, and ER visits. EoE patients experiencing dilation had high HCRU and cost burden, highlighting the importance of achieving disease control to prevent fibrostenotic complications and consequent esophageal dilations.

	Unadjusted			Adjusted
	EoE n=15,432	Non EoE n=15,432	P-value	EoE n=15,432	Non EoE n=15,432	P-value
Mean HCRU per patient, (SD)
Number of prescriptions filled	20.0 (22.4)	10.5 (17.9)	< 0.0001	20.6 (0.2)	11.6 (0.2)	< 0.0001
Number of days with outpatient visit	16.5 (19.9)	7.3 (11.5)	< 0.0001	15.3 (0.2)	8.4 (0.1)	< 0.0001
Number of inpatient visits	0.5 (4.0)	0.3 (5.5)	< 0.0001	0.6 (0.2)	0.5 (0.1)	0.05
Number of days with inpatient visit	0.6 (5.8)	0.4 (5.6)	< 0.0001	0.9 (0.4)	0.8 (0.3)	0.134
Number of days with ER visit	0.6 (1.6)	0.2 (0.8)	< 0.0001	0.5 (0.0)	0.2 (0.0)	< 0.0001
Number of days with another medical visit	1.3 (2.8)	0.7 (1.6)	< 0.0001	1.2 (0.0)	0.8 (0.0)	< 0.0001
Mean costs per patient, $ (SD)
Prescription costs	4,385 (17,990)	1,938 (11,322)	< 0.0001	3,908 (140)	2,270 (113)	< 0.0001
Outpatient costs	7,533 (14,579)	2,760 (8387)	< 0.0001	7,316 (143)	3,103 (78)	< 0.0001
Inpatient costs	1,842 (18,466)	1,173 (11,832)	< 0.0001	1,549 (138)	1,466 (128)	0.69
ER costs	1,039 (4517)	422 (3233)	< 0.0001	943 (33)	478 (30)	< 0.0001
Other medical costs	255 (2086)	92 (512)	< 0.0001	232 (17)	105 (6)	< 0.0001
Total medical costs	10,669 (26,555)	4,448 (16,314)	< 0.0001	10,214 (239)	4,985 (146)	< 0.0001
Total healthcare costs	15,054 (35,801)	6,386 (21,528)	< 0.0001	15,354 (418)	7,262 (206)	< 0.0001

Table: Table. Annual HCRU and Healthcare Costs of Patients With EoE and Non-EoE Controls During Follow-up.

Disclosures:

Mirna Chehade: Adare/Ellodi – Consultant, Grant/Research Support. Allakos – Consultant, Grant/Research Support. AstraZeneca – Consultant, Grant/Research Support. Bristol Myers Squibb – Consultant. Danone – Grant/Research Support. Phathom – Consultant. Regeneron – Consultant, Grant/Research Support. Sanofi – Consultant. Shire/Takeda – Consultant, Grant/Research Support.

Andrew Epstein: Medicus Economics, LLC – Employee.

Eilish McCann: Regeneron Pharmaceuticals, Inc. – Employee, Stock Options.

Sarette Tilton: Sanofi – Employee, Stock Options.

Arpita Nag: Sanofi – Employee, Stock Options.

Chao Chen: Regeneron Pharmaceuticals Inc. – Employee, Stock Options.

Degang Wang: Regeneron Pharmaceuticals Inc. – Employee, Stock Options.

Tiffany Pela: Sanofi – Employee, Stock Options.

Angela Khodzhayev: Regeneron Pharmaceuticals – Employee, Stock Options.

Ryan Thomas: Regeneron Pharmaceuticals, Inc – Employee, Stock Options.

Mirna Chehade, MD, MPH¹, Andrew J. Epstein, PhD², Eilish McCann, PhD³, Sarette T. Tilton, BSc, PharmD⁴, Arpita Nag, MBA, MS, PhD⁵, Chao Chen, BSc, PhD³, Degang Wang, BSc, PhD³, Tiffany Pela, MPH, PharmD⁵, Angela Khodzhayev, PharmD³, Ryan Thomas, PharmD, MS⁶. A0192 - Health Care Resource Utilization and Costs Among Eosinophilic Esophagitis Patients in the United States, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.