Eosinophilic Esophagitis-Related Healthcare Resource Utilization and Associated Costs for Payers and Patients: A Retrospective Cohort Study of US Health Insurance Claims Data
Author(s)
Evan S Dellon, MD1, bridgett Goodwin, PhD2, Echo Liu, PhD2, Bertha de los Santos, PharmD3, Siddhi Korgaonkar, PhD4, Juliana Meyers, MA4, Carolyn Schaeffer-Koziol, PhD2, Brian Terreri, PharmD2, Eric D. Shah, MD5;
1Department of Medicine, University of North Carolina at Chapel Hill, Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Chapel Hill, NC, USA, 2Takeda Pharmaceuticals USA, Inc., Lexington, MA, USA, 3Takeda Pharmaceuticals USA, Inc., Chicago, IL, USA, 4RTI Health Solutions, Research Triangle Park, NC, USA, 5University of Michigan, Division of Gastroenterology and Hepatology, Ann Arbor, MI, USA
1Department of Medicine, University of North Carolina at Chapel Hill, Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Chapel Hill, NC, USA, 2Takeda Pharmaceuticals USA, Inc., Lexington, MA, USA, 3Takeda Pharmaceuticals USA, Inc., Chicago, IL, USA, 4RTI Health Solutions, Research Triangle Park, NC, USA, 5University of Michigan, Division of Gastroenterology and Hepatology, Ann Arbor, MI, USA
Presentation Documents
OBJECTIVES: This study assessed eosinophilic esophagitis (EoE)-related healthcare resource utilization (HCRU) and associated costs for patients with EoE in the USA from the perspective of payers and patients.
METHODS: This retrospective, observational cohort study examined US health insurance claims data from the Merative MarketScan Commercial, Medicare Supplemental and Medicaid databases (July 1, 2020-June 30, 2023). Eligible patients had ≥1 inpatient or outpatient claim with a diagnosis code for EoE (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM]: K20.0 [index date]) and 12 months of continuous health plan enrollment before and after the index date (baseline and follow-up periods, respectively). Patients with a diagnosis code for eosinophilic gastritis/gastroenteritis (ICD-10-CM: K52.81) post-index were excluded.
RESULTS: Overall, 19,169 patients with EoE were identified: mean (standard deviation [SD]) age 35.8 (18.5) years; 60.3% male; 73.7% commercially insured. EoE-related HCRU (proportion of patients who had ≥1 visit days) was higher during the follow-up than baseline period for most visit types, except for emergency department (ED) (17.1% vs 14.1%) and urgent care visits (2.1% vs 1.7%), where utilization was higher during the baseline period. The median number of claims/patient was slightly higher during the follow-up than baseline period for prescription claims (4 vs 5). The annual mean (SD) EoE-related total healthcare cost/patient among those with ≥1 EoE-related claim was US$3729 (US$8594) at baseline and increased to US$5331 (US$10,217) during follow-up; the increase was primarily driven by outpatient hospital visits, pharmacy costs and home visits. During follow-up (i.e. after diagnosis), inpatient and ED costs decreased from baseline. EoE-related costs accounted for 22.2% of all-cause healthcare costs at baseline and 28.6% of those during follow-up.
CONCLUSIONS: EoE represents a substantial healthcare burden; the increases in HCRU and costs after diagnosis may be attributed to increases in routine assessments and prescriptions. However, inpatient and ED costs decreased after diagnosis.
METHODS: This retrospective, observational cohort study examined US health insurance claims data from the Merative MarketScan Commercial, Medicare Supplemental and Medicaid databases (July 1, 2020-June 30, 2023). Eligible patients had ≥1 inpatient or outpatient claim with a diagnosis code for EoE (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM]: K20.0 [index date]) and 12 months of continuous health plan enrollment before and after the index date (baseline and follow-up periods, respectively). Patients with a diagnosis code for eosinophilic gastritis/gastroenteritis (ICD-10-CM: K52.81) post-index were excluded.
RESULTS: Overall, 19,169 patients with EoE were identified: mean (standard deviation [SD]) age 35.8 (18.5) years; 60.3% male; 73.7% commercially insured. EoE-related HCRU (proportion of patients who had ≥1 visit days) was higher during the follow-up than baseline period for most visit types, except for emergency department (ED) (17.1% vs 14.1%) and urgent care visits (2.1% vs 1.7%), where utilization was higher during the baseline period. The median number of claims/patient was slightly higher during the follow-up than baseline period for prescription claims (4 vs 5). The annual mean (SD) EoE-related total healthcare cost/patient among those with ≥1 EoE-related claim was US$3729 (US$8594) at baseline and increased to US$5331 (US$10,217) during follow-up; the increase was primarily driven by outpatient hospital visits, pharmacy costs and home visits. During follow-up (i.e. after diagnosis), inpatient and ED costs decreased from baseline. EoE-related costs accounted for 22.2% of all-cause healthcare costs at baseline and 28.6% of those during follow-up.
CONCLUSIONS: EoE represents a substantial healthcare burden; the increases in HCRU and costs after diagnosis may be attributed to increases in routine assessments and prescriptions. However, inpatient and ED costs decreased after diagnosis.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE120
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Gastrointestinal Disorders