Eosinophilic Esophagitis-Related Healthcare Resource Utilization and Associated Costs for Payers and Patients: A Retrospective Cohort Study of US Health Insurance Claims Data
Moderator
bridgett Goodwin, Takeda, Cambridge, MA, United States
Speakers
Evan S Dellon; Echo Liu, PhD, Takeda Pharmaceuticals U.S.A., Cambridge, MA, United States; Bertha de los Santos; Siddhi Korgaonkar; Juliana Meyers; Carolyn Schaeffer-Koziol; Brian Terreri; Eric Shah
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