(383) Healthcare burden of eosinophilic esophagitis by disease severity: a retrospective cohort study of US health insurance claims data

Background: : Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease. If inadequately treated, it can progress from an inflammatory to a more severe, fibrostenotic phenotype.

Objective: : To assess EoE-related healthcare resource utilization (HCRU) and costs, stratified by disease severity, in patients with EoE in the USA.

Methods: : This retrospective, observational cohort study examined US health insurance claims data from the Merative MarketScan Commercial, Medicare Supplemental and Medicaid databases between July 1, 2020, and June 30, 2023. Patients with ≥1 inpatient/outpatient claim for EoE (ICD-10-CM: K20.0) were included. The date of the first observed EoE claim during the selection window (July 1, 2021–June 30, 2022) was the index date. Patients required continuous enrollment 12 months before (baseline) and 12 months after the index date (follow-up). Using a claim-based algorithm adapted from the Index of Severity for EoE, disease severity was classified as mild, moderate or severe based on EoE-related diagnoses, procedures and complications reported during the baseline period + 30 days post-index date. EoE-related HCRU and costs during the baseline and follow-up periods, stratified by severity, were reported.

Results: : Overall, 19,169 patients with EoE were identified. EoE severity was classified as mild, moderate and severe in 67.5%, 24.9% and 7.6% of patients, respectively. In general, EoE-related HCRU increased from baseline to follow-up and from mild to severe disease (data not shown). Mean (SD) total healthcare costs/patient/year (medical + pharmacy) during baseline versus follow-up periods were: mild, $2623 ($6883) vs $4608 ($9054); moderate, $3596 ($6961) vs $5399 ($8077); and severe, $10,317 ($19,661) vs $12,787 ($22,334). Mean (SD) pharmacy costs/patient/year during baseline versus follow-up periods were: mild, $818 ($4136) vs $1308 ($5688); moderate, $500 ($3823) vs $1026 ($5464); and severe, $1505 ($4518) vs $2135 ($6190). Overall, 414 (2.2%) patients with EoE had a claim for dupilumab (the only FDA-approved medication at the time of this study); most patients with claims for dupilumab had mild EoE (mild, 69.1%; moderate, 19.8%; severe, 11.1%). During the follow-up period, patients who had a claim for dupilumab had higher total mean (SD) EoE-related healthcare costs than those who did not ($31,591 [$21,023] vs $4852 [$9567]).

Conclusions: : The higher HCRU and healthcare costs associated with severe EoE highlight the importance of early diagnosis and prompt treatment.

Sponsorship:: Takeda Pharmaceuticals USA, Inc.