The Epidemiology and Cost of Inpatient Care for Patients With Eosinophilic Esophagitis in the United States

Abstract

Introduction: Although a rare chronic condition with increasing recognition, evidence suggests that eosinophilic esophagitis (EoE) contributes significantly to healthcare cost for commercially insured individuals in the United States. However, there is limited information on the direct cost of inpatient care for patients with EoE. This study describes the epidemiology and costs of inpatient care for the US population with EoE. Methods: This is a cross-sectional case-control design utilizing the National Inpatient Sample (NIS) database between 2010 and 2013 from the Healthcare Cost and Utilization Project (HCUP). EoE cases were identified using ICD-9 discharge code 530.13. Three inpatient controls were randomly selected for each case of EoE, matched based on gender, age, and race. Control subjects with chronic conditions (e.g. chronic bronchitis, chronic renal disease, asthma) were further selected for analysis. We assessed length of stay (LOS), total charges, sources of payment, and cost of procedures including esophagogastroduodenoscopy (EGD), allergy testing and esophageal dilation. Results: There were 16,518 admissions associated with EoE over the four-year period, with increasing admission rates over time. Most of the patients were below 19 years of age (41%) and were Caucasian (80%). The median length of stay (LOS) and total cost of EoE inpatient care was approximately 2 days (interquartile range (IQR), 1-4) and $20,350 (IQR, $11,355 - $37, 207) respectively per patient, compared to controls with median LOS of 3 days (IQR, 1-5) and total cost of $20,441 ($10,572-$41,417). EGD with closed biopsy in EoE patients accounted for about 91% of the procedures during admission with average and median cost of $37,834 (+/-$1699) and $24,639 (IQR, $15,441 - $41,286) respectively. The sources of payment among EoE patients were mostly private insurance (56%) and Medicaid (20%). The peak admission periods were between March to May and August to October. Conclusion: Increasingly, EoE is being shown to constitute a significant health burden, necessitating prompt attention. The severity of this disorder may demand inpatient admission and close monitoring. This study describes the characteristics and cost of inpatient care including LOS, cost of procedure and total hospital charge. Our study suggests there is a significant increase in inpatient cost per day for individuals with EoE compared to controls. Development of non-invasive procedures for monitoring EoE disease progression will be critical to reduce the inpatient cost of care in this population.