Abstract
IntroductionTreatments of interstitial lung diseases (ILDs) mainly focus on disease stabilization and relief of symptoms by managing inflammation or suppressing fibrosis by (in part costly) drugs. To highlight economic burden of drug treatment in different ILD-subtypes we assessed cost trends and therewith-associated drivers.MethodsUsing data from the German, observational HILDA study we estimated adjusted mean medication costs over 36-month intervals using one- and two-part Generalized Estimating Equation (GEE) regression models with a gamma distribution and log link. Next, we determined factors associated with costs.ResultsIn Idiopathic pulmonary fibrosis (IPF) mean per capita medication costs increased from €1442 before to €11,000€ at the end of study. In non-IPF subtypes, the increase took place at much lower level. Mean per capita ILD-specific medication costs at the end of the study ranged between €487 (other ILD) and €9142 (IPF). At baseline, higher FVC %predicted values were associated with lower medication costs in IPF (−9%) and sarcoidosis (−1%). During follow up higher comorbidity burden escalated costs in progressive fibrosing ILD (PF-ILD) (+52%), sarcoidosis (+60%) and other ILDs (+24%). The effect of disease duration was not uniform, with cost savings in PF-ILD (−8%) and sarcoidosis (−6%), but increased spending in IPF (+11%).ConclusionPharmacological management of ILD, in particular of IPF imposes a substantial economic burden on the healthcare system. Strategies to reduce comorbidity burden and early treatment may reduce the impact of ILDs on the healthcare system.
Highlights
Treatments of interstitial lung diseases (ILDs) mainly focus on disease stabilization and relief of symptoms by managing inflammation or suppressing fibrosis by drugs
ILDs that are associated with this phenotype include sarcoidosis, non-specific interstitial pneumonia (NSIP), Connective tissue diseases (CTD-ILD), hypersensitivity pneumonitis (HP) and unclassifiable ILD [11]
The ILD subtypes differed in terms of disease duration, age and comorbidity burden, with the difference being most pronounced between idiopathic pulmonary fibrosis (IPF) and sarcoidosis
Summary
Treatments of interstitial lung diseases (ILDs) mainly focus on disease stabilization and relief of symptoms by managing inflammation or suppressing fibrosis by (in part costly) drugs. Idiopathic ILDs, referred to as idiopathic interstitial pneumonias (IIPs)—which include idiopathic pulmonary fibrosis (IPF) as their most prominent form—represent. Within the various non-IPF ILDs, a proportion of patients can develop a progressive, fibrosing phenotype. This phenotype is characterized by declining lung function and high mortality [11, 12]. In contrast to IPF progressive fibrosing ILDs (PF-ILD) are often accompanied by inflammation. ILDs that are associated with this phenotype include sarcoidosis, non-specific interstitial pneumonia (NSIP), CTD-ILD, HP and unclassifiable ILD [11]
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