HEALTHCARE RESOURCE USE AND COST IN ANTIFIBROTIC-TREATED VS UNTREATED PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS (IPF) IN THE US MEDICARE POPULATION

Abstract

SESSION TITLE: Diffuse Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In October 2014, 2 antifibrotic therapies, pirfenidone and nintedanib, were approved to treat IPF. This study compared all-cause and respiratory healthcare utilization (HCU) and costs in patients (pts) with IPF initiating antifibrotics vs. untreated pts. METHODS: A retrospective observational study of Medicare beneficiaries using 100% Medicare Research Identifiable Files compared 2 cohorts of pts with IPF: 1) pts with IPF who initiated antifibrotic therapy from 10/15/2014 (FDA approval date) to 12/31/2017 and who had ≥1 IPF claim on or before the date of initiation (index date) and 2) pts with IPF who did not receive antifibrotic therapy between 1/1/2012 and 10/14/2014 (historical controls) and who were indexed by the first IPF claim in that period. IPF diagnosis was confirmed by the presence of ≥1 inpatient or ≥2 outpatient IPF claims in the entire study period (Jan 2010 to Dec 2017). Patients were followed up to end of enrollment, lung transplant, switching or stopping index treatment (censoring occurred 60 days after treatment stop), death, or study end. Patients had various length of follow-up. Historical controls were matched to antifibrotic initiators using propensity score methods based on several patient characteristics including age, gender, region, socioeconomic status and Charlson comorbidity index. Costs and HCU (measured per patient month [PPM], weighted by follow-up length) were compared in pts who initiated antifibrotics vs. pts with IPF prior to antifibrotic approvals. RESULTS: 4993 pts with IPF initiating antifibrotics were identified; propensity scores matched 4641 (93%) with untreated controls; 352 unmatched treated pts (7%) were excluded. All-cause and respiratory costs PPM for treated vs untreated were: outpatient services, $1171 vs $1917 and $604 vs $981, respectively; inpatient services, $1584 vs $3058 and $820 vs $1624; outpatient medications, $7883 vs $401 and $7488 vs $3749 (p<0.001 each). The average number of all-cause inpatient hospitalizations (treated: 0.104 (0.33), matched untreated: 0.160 (0.41), p<0.001); and ICU stays (treated 0.052 (0.28), matched untreated: 0.07 (0.29), p<0.001) per month. Mean respiratory-related inpatient hospitalizations (treated: 0.052 (0.24), matched untreated: 0.085 (0.31), p<0.001) and ICU stays (treated: 0.027 (0.20), matched untreated: 0.039 (0.23), p<0.001). CONCLUSIONS: Healthcare utilization and all-cause and respiratory inpatient costs were statistically significantly lower in treated vs untreated patients with IPF. CLINICAL IMPLICATIONS: Although outpatient medications were higher in the treated group, antifibrotic use may help reduce healthcare utilization and inpatient costs for patients with IPF by reducing hospitalizations and length of stay. DISCLOSURES: Employee relationship with PHAR, LLC Please note: $20001 - $100000 Added 05/19/2020 by Michael Broder, source=Admin input, value=Multi-pharma funded research No relevant relationships Added 04/15/2020 by Eunice Chang, source=Web Response, value=Consulting fee Removed 04/29/2020 by Eunice Chang, source=Web Response Employee relationship with Genentech, Inc. Please note: >$100000 Added 04/13/2020 by Mitra Corral, source=Web Response, value=Salary No relevant relationships by Sohum Gokhale, source=Web Response Consultancy hired to conduct research relationship with Genentech Please note: >$100000 Added 04/15/2020 by Sheila Reddy, source=Web Response, value=Consulting fee