Fee, Rebecca M.

Background: The economic burden associated with idiopathic pulmonary fibrosis (IPF) is not well understood, especially since the approval of antifibrotic medications to treat IPF in 2014. Objective: This study assessed healthcare resource utilization (HCRU) and costs for patients with and without IPF among insured patients in the United States. Methods: This retrospective study used claims data from the Optum Research Database from 01 January 2016 through 31 December 2023. The IPF cohort included patients with at least 2 claims for IPF within 365 days. A comparator cohort was exact matched to the IPF cohort in a 4:1 ratio on demographic characteristics. Follow-up all-cause and respiratory-related HCRU and costs were collected. Outcomes were presented as weighted per-patient per-month (wPPPM) to account for variable follow-up. Descriptive results were reported by cohort, overall, and stratified by insurance type. All-cause and respiratory-related wPPPM costs were modeled using generalized linear models and time to all-cause and respiratory-related inpatient visits were modeled using Cox proportional hazards regression models, adjusted for baseline comorbidities. Results: A total of 7582 patients were included in the IPF cohort; 10.4% were commercially insured and 89.6% insured by Medicare Advantage Prescription Drug (MAPD) plans. The comparator cohort included 30 328 demographically matched controls. Overall, mean all-cause wPPPM counts of HCRU during follow-up were significantly higher in the IPF cohort than the comparator cohort for all categories (all P < .001). Similarly, mean (SD) follow-up all-cause wPPPM total healthcare costs were higher for the IPF cohort than the comparator cohort ($4667 [$8252] vs $1196 [$2114], P < .001). After adjustment, the cost ratio for all-cause total healthcare costs between the IPF and comparator cohorts was 3.4 (95% confidence interval [CI], 3.10-3.64), and patients in the IPF cohort were 2.1 times (95% CI, 1.97-2.15) more likely to be hospitalized for all causes than the comparator cohort. For both HCRU and costs, similar patterns were observed in both the commercial and MAPD populations. Conclusion: Patients with IPF incurred substantially higher HCRU and costs than the demographically matched comparator cohort. Study results suggest the need for treatment options to improve management of IPF and reduce costly HCRU.

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&lt;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&lt;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&lt;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.