THE CONTROVERSY OF THE EPIPEN: A COST-BENEFIT ANALYSIS AND WHAT IT MEANS FOR CARE PROVIDERS

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: In 2007, Mylan purchased the EpiPen. Since then the cost of the EpiPen has soared. The wholesale acquisition cost (WAC) has risen from $93.88 – $349.19 between the years 2007 – 2014. This abstract is an analysis of the overall trends seen with the rising WAC of the EpiPen and its effect on multiple variables. Analysis of trends were also done in association with passing of the Affordable Health Care Act (ACA) METHODS: Patients with a principal diagnosis of anaphylaxis (ICD9 code 995.0) within Nationwide Emergency Department Sample database and National Inpatient Sample database between 2006 – 2014 were identified. Data relating to demographics, type of insurance, emergency room (ED) disposition, in-hospital length of stay (LOS), in-patient mortality were extracted. Intubation and mechanical ventilation utilization data was extracted. The WAC of the EpiPen, (defined as the manufacturer’s list price for the drug to wholesalers or direct purchases in the United States) was sourced from the Elsevier Clinical Solutions' Gold Standard Drug Database. Correlations of rising WAC to ED visits, need for mechanical ventilation, mortality, rising hospital cost were made using trend analysis. Spearman correlation was used to define trends prior to and after the passing of the ACA. RESULTS: A total of 47,008 patients with the diagnosis of anaphylaxis were identified and included in this study. Average age of patients were 42 years, with insurance coverage consisting of Medicare 19.31%, Medicaid 16.35%, private insurance 48%, self pay 10.95%. Overall the rising cost of the EpiPen was associated with increased ED visits (spearman rank order correlation rho = 0.9987; p=0.0001) and increased LOS (spearman rho= 0.0663; p=0.01). Trend analysis before and after the ACA legislation passed in 2010 was also performed. Rising cost of ED visits and inpatient management was unchanged by passing of the ACA; however decline in LOS; p=0.0051 and requirement of mechanical ventilation; p=0.035 was seen. Total number of ED visits increased despite implementation of universal insurance; p=0.001. There was no change in mortality. Trend analysis looking at patients with Medicaid coverage revealed rising mean LOS, mortality, ventilation requirement associated with increase in WAC of EpiPen prior to implementation of ACA and a steady decline post passing of the legislation. CONCLUSIONS: Rising EpiPen WAC was associated with increased ED visits and increase LOS between 2007 and 2014. Trend analysis revealed rising cost of the EpiPen was associated with increase mean LOS, mortality and ventilation requirement prior to ACA implementation. With ACA implementation, despite increased WAC, there was a steady decline in mean LOS, mortality and ventilation requirement. ED visits cost and inpatient hospital cost continued to increase from 2007–2014. CLINICAL IMPLICATIONS: Rising cost of life-saving interventions has detrimental down stream effects. DISCLOSURES: No relevant relationships by kimberley cousins, source=Web Response No relevant relationships by Alem Mehari, source=Web Response No relevant relationships by Funmilola Ogundipe, source=Web Response No relevant relationships by Richard Ogunti, source=Web Response