Xu X, Kwiatek J, Chehade M, Aceves S, Maslova E, Kielar D, Stirnadel-Farrant H, Meyers J, Candrilli S, Katial R. Characteristics of and healthcare cost drivers among U.S. patients with eosinophilic esophagitis with high versus non-high all-cause costs: an analysis of insurance claims data. Poster presented at the 2022 American College of Gastroenterology (ACG) Annual Scientific Meeting; October 24, 2022. Charlotte, NC.

INTRODUCTION: Data on healthcare resource utilization (HCRU) and costs in patients with eosinophilic esophagitis (EoE) are limited. We examined all-cause HCRU and costs in US patients with newly diagnosed EoE, comparing differences in demographic/clinical characteristics and cost drivers between those considered high-cost (HC) and non-high-cost (NHC).

METHODS: Retrospective analysis of 2017–2021 MarketScan Commercial and Medicare administrative claims data including EoE patients with ≥12 months’ continuous health plan enrollment pre- and post-first observed EoE diagnosis code (index date). Patients were stratified by all-cause HCRU cost group (HC vs NHC) and age (<12, 12–17, ≥18 years). HC was defined post hoc as a post-index date all-cause cost distribution ≥$30,000. Annual per-patient costs were reported by care setting for the 12-months pre- and post-index date; demographic/clinical characteristics were considered at index. Statistical analyses were descriptive.

RESULTS: 12,694 patients had incident EoE (mean age 38 years, 63% male), with pre- and post-diagnosis average annual all-cause costs of $9,643 and $14,573 per patient, respectively. The HC group (n=1,259, 9.9% of all incident patients) had a higher proportion of children, adolescents and females and a higher mean Charlson Comorbidity Index score than the NHC group (Table). The HC group had 7.4- and 10.0-fold higher pre- and post-diagnosis all-cause costs than the NHC group, respectively. Post-EoE diagnosis, the key cost drivers for all-cause costs were inpatient stays (24%; mostly unrelated to EoE), and hospital outpatient visits (30%) for the HC group, and hospital outpatient visits (42%) and physician office visits (20%) for the NHC group. Pharmacy costs were a notable cost driver in the HC group pre- and post-EoE diagnosis (35% and 26%) compared with the NHC group (15% and 16%). Inpatients costs increased 2.2-fold during the post- vs pre-diagnosis period in the HC group but decreased by 66% in the NHC group. Adolescents in both groups had higher all-cause costs than adults.

DISCUSSION: EoE patients comprising the HC group had a higher proportion of children, adolescents and females and a greater comorbidity burden than the NHC group. Following EoE diagnosis, though most costs were unrelated to EoE, a substantial increase in inpatient stay costs was observed in the HC group vs a reduction in the NHC group. The differences observed between these two groups require further evaluation.

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