(375) Socioeconomic disparities in healthcare resource utilization and costs among Medicare Fee-for-Service beneficiaries with progressive pulmonary fibrosis

Background: : Fibrosing interstitial lung disease (ILD) that progresses is known as progressive pulmonary fibrosis (PPF). Socioeconomic factors affect access to care and health outcomes, yet evidence on related disparities is limited.

Objective: : This study aimed to describe potential disparities in healthcare resource utilization (HCRU) and costs among Medicare Fee-for-Service (FFS) beneficiaries with PPF by socioeconomic status (SES).

Methods: : This retrospective cohort study used the Medicare FFS claims database to identify beneficiaries with PPF between January 2017 and June 2024. First, patients newly diagnosed with ILD were identified by ≥2 claims with a relevant diagnosis code on separate dates within 365 days. Then, patients with evidence of progression were identified using claims-based proxy measures, with the earliest date of progression set as the index date. Continuous enrollment for 12 months before and ≥1 month after index date was required. All-cause and PPF-related HCRU and costs were assessed, stratified by separate covariates that indicate lower SES (i.e., eligibility for Part D low-income subsidy [LIS] and dual-eligibility [DE] for Medicare and Medicaid). All outcomes were analyzed descriptively.

Results: : A total of 257,280 patients with PPF were identified (mean age: 74 years), and the majority were female (61.5%) and non-Hispanic White (80.4%). The majority were of higher SES, as reflected by distributions for DE status (full DE: 22.9%; partial DE: 5.9%; not DE: 71.2%) and LIS eligibility status (eligible with full subsidy: 29.5%; eligible with partial subsidy: 2.8%; ineligible: 74%). Patients in lower SES groups consistently had higher HCRU and costs. Mean (SD) all-cause inpatient visits per patient per month (PPPM) were highest among patients with full DE (0.40 [0.68]), followed by partial DE (0.30 [0.38]), and not DE (0.23 [0.33]). All-cause emergency room visits showed a similar gradient (full DE: 0.42 [0.57]; partial DE: 0.37 [0.45]; not DE: 0.25 [0.29]). Mean (SD) all-cause total medical costs PPPM were $10,429 [$14,337] for full DE, $7,771 [$11,220] for partial DE, and $6,818 [$10,470] for not DE patients. Similar trends were observed for LIS status.

Conclusions: : Among Medicare beneficiaries with PPF, lower SES was associated with higher HCRU and costs, reflecting potential disparities in access to care and disease burden. These findings underscore the need for targeted strategies and interventions to address underlying disparities in care and enhance outcomes in this vulnerable population.

Sponsorship:: Boehringer Ingelheim