Le, Lisa

Abstract RATIONALE: Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease characterized by chronic and progressive decline in lung function with unknown cause. Previous economic burden of IPF estimates were based on data from 2011 or earlier. Thus, more current estimates will help inform policymaking. This study aimed to quantify the healthcare resource utilization (HCRU) and direct costs associated with IPF, overall and by payer type (commercial or Medicare Advantage Prescription Drug [MAPD] plan). METHODS: This retrospective cohort study used the Optum® Research claims database from 01/01/2016 through 12/31/2023. Adult patients with IPF (defined as ≥2 claims with IPF diagnosis code within 365 days) were identified (IPF cohort), with the date of the first IPF medical diagnosis code set as the index date. A general population without IPF (control cohort) was exact matched to the IPF cohort in 1:4 ratio, based on age group, sex, geographical region, payer type (commercial vs. MAPD), and race/ethnicity. The assigned index date for the control cohort was the same as the index date of the matched IPF patient. Continuous enrollment of 12 months before and 3 months after the index date was required for both cohorts. All-cause and respiratory-related HCRU and direct costs were compared between the cohorts during the variable follow-up period, reported as observation time-weighted per-patient-per-month (wPPPM). RESULTS: A total of 7,670 IPF patients were exact matched to 30,680 control patients. The mean age was 76 years and 59% were male. HCRU during the follow-up was significantly greater across all categories in the IPF cohort compared to control cohort (p<0.001) (Table 1). The mean (standard deviation [SD]) wPPPM all-cause total healthcare costs were nearly four times higher for the IPF cohort compared to control cohort ($4,724 [$8,368] vs. $1,197 [$2,134], p<0.001). Hospitalization costs accounted for the largest proportion of all-cause medical costs for the IPF cohort (55%), whereas ambulatory costs were the largest for the control cohort (49%). The IPF cohort had significantly higher wPPPM pharmacy costs compared to the matched control cohort ($2,289 [$3,861] vs. $321 [$1,133], p<0.001) (Table 1). Similar trends were observed in respiratory-related HCRU and costs. When stratified by payer types, the total costs were significantly higher for commercially insured patients compared to patients with MAPD plan. CONCLUSION: The study demonstrated that patients with IPF incur higher economic burden compared to those without the disease, highlighting the need for more effective treatments to reduce costly healthcare resource utilization.

65 Background: There is consensus that the proportion of the average-risk US population up-to-date with CRC screening (58-65%) is insufficient. However, estimates of average risk CRC screening rates are inconsistent and impacted by inclusion of higher-risk individuals, and differing study designs. Accurate measurement of population screening rates is key to addressing gaps in care and assessing the impact of newer CRC screening tests. Methods: The study included individuals aged 50-75 years in a large de-identified claims database, with continuous enrollment during year of analysis, and a variable length baseline enrollment of 1-10 years. Average-risk designation excluded higher risk diagnoses (CRC familial syndromes, colorectal polyp or history of colorectal polyp, history of/current CRC, family history of gastrointestinal cancer, and inflammatory bowel disease). Up-to-date status was assessed within guideline-based time periods: colonoscopy (10 years); FIT or FOBT (annually); mt-sDNA (3 years); flexible sigmoidoscopy/CT colonography (5 years). Analyses assessed the proportion estimated as up-to-date and examined the sensitivity to: a) patient population (average-risk only vs. including higher-risk); b) study design (yearly cross-sectional vs. cohort of 50-year-old patients; c) methods (percent in patients with 10 years of enrollment vs. Kaplan Meier (KM) of censored variable pre-screening period). Results: The cross-sectional analysis average-risk population included 5.3 million individuals. Estimates of the proportion of those up-to-date with screening guidelines for average-risk patients varied by study design, population, and estimation method. KM estimates among the average-risk population (50-75) showed 49-50% were up-to-date in each calendar year. Including higher-risk patients in the KM analysis resulted in 70% up-to-date among the mixed average+higher-risk population. Using a cohort study design (average-risk patients aged 60 with 10 years of baseline data), 65% were up-to-date by age 60. Conclusions: In the base case analysis only half of average risk individuals were up-to-date with CRC screening, a rate lower than typically cited. Sensitivity analyses resulted in substantially different estimates and demonstrate the importance of clearly communicating the methodology used to define the study population. Higher rates quoted in the lay press and medical publications may be based on mixed populations of average+higher-risk individuals or on study designs that do not represent the full population at risk.