HEALTHCARE RESOURCE USE AND COSTS IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS IN THE US MEDICARE POPULATION

Abstract

SESSION TITLE: Monday Electronic Posters 3 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Two idiopathic pulmonary fibrosis (IPF) therapies (pirfenidone and nintedanib) that slow disease progression were approved in 2014 in the United States. We examined healthcare utilization (HCU) and costs associated with these antifibrotic therapies in the Medicare patient population. METHODS: A retrospective observational study of Medicare beneficiaries using the 100% Medicare Research Identifiable File was conducted. Patients aged 67+ diagnosed with IPF (≥1 inpatient or outpatient claim with diagnosis [ICD-9-CM: 516.3, 516.30, 516.31; ICD-10-CM: J84.111, J84.112]) during the study period (1/2010-12/2015) on or before initiation of antifibrotic therapy (index date) between (10/15/2014-12/31/2015) were included. The cohort was divided into 2 groups: pirfenidone or nintedanib initiators. HCU except hospitalization and costs were measured as monthly outcomes (per patient per month, PPPM) during the treatment period and weighted by follow-up length. Claims with primary diagnosis of respiratory disease (ICD-9-CM: 460.xx - 519.xx; ICD-10-CM: J00.xx-J99.xx) or a diagnosis of respiratory disease in any field were defined as respiratory-related for inpatient and outpatient services, respectively. Stabilized inverse probability of treatment weighting using the propensity score (PS) adjusted the baseline confounding factors. To estimate the PS, baseline covariates included: age, gender, region, Charlson comorbidity index (excluding COPD), COPD, stroke, newly diagnosed IPF, pneumonia 3 months prior to initiation, quartile of median income of patient residential area and distance from patient residential area to ILD specialty center. RESULTS: The study identified 3546 patients diagnosed with IPF (2082 pirfenidone, 1464 nintedanib) who initiated antifibrotics. All-cause inpatient costs PPPM (mean, SD) were: pirfenidone ($1129, $3992.6), nintedanib ($1494, $5317.7), P=0.026; all-cause outpatient service costs PPPM: pirfenidone ($1042, $1453.6), nintedanib ($1072, $1462.8), P=0.553; respiratory-related inpatient costs PPPM: pirfenidone ($581, $2559.1), nintedanib ($833, $4180.1), P=0.041; all-cause inpatient hospitalizations: pirfenidone 20.0%, nintedanib 22.6%, P=0.066; days of stay in the hospital: pirfenidone 8.1 days, nintedanib 9.4 days, P=0.101; respiratory-related hospitalizations: pirfenidone 11.1%, 12.4% nintedanib, P=0.257; days of stay in hospital: pirfenidone 7.2 days, nintedanib 9.3 days, P=0.043. CONCLUSIONS: Differences were observed in all-cause inpatient costs, respiratory-related inpatient costs, and respiratory-related hospitalization days between antifibrotics. Respiratory-related hospitalizations have been associated with an increased risk of death in IPF. CLINICAL IMPLICATIONS: Patients receiving pirfenidone vs nintedanib may have overall lower all-cause inpatient costs and fewer respiratory-related hospital days. DISCLOSURES: No relevant relationships by Michael Broder, source=Web Response No relevant relationships by Eunice Chang, source=Web Response Employee $100000 Added 03/06/2019 by Mitra Corral, source=Web Response, value=Salary<br No relevant relationships by Sohum Gokhale, source=Web Response Employee relationship with PHAR, LLC Please note: >$100000 Added 03/13/2019 by Sheila Reddy, source=Web Response, value=Salary