Characteristics, treatment patterns, healthcare resource utilization, and costs in patients with eosinophilic esophagitis in the United States

Abstract

Background: Eosinophilic esophagitis (EoE) is characterized by eosinophil infiltration into the esophageal tissue and esophageal dysfunction. In the United States, EoE has an estimated prevalence of 26-163 cases per 100,000 people. Real-world data concerning the clinical burden of EoE and treatment patterns in the United States are limited.Objectives: To describe the demographics, clinical characteristics, symptoms, comorbidities, treatment pathways, and healthcare resource utilization (HCRU) and costs among patients with EoE in the United States.Design: Retrospective analysis.Methods: A study of pediatric and adult patients diagnosed with incident EoE (full incident EoE cohort) using Merative (TM) MarketScan (R) health insurance claims data between January 1, 2017, and June 30, 2020. A subset of patients (matched incident EoE cohort) was matched with patients without EoE for age, sex, and payor (matched control cohort). Follow-up was 12 months after the EoE diagnosis date. All statistics are descriptive.Results: The full incident EoE cohort included 20,290 patients (62.61% were male; median (range) age was 38 (1-93) years); 13,710 patients (matched incident EoE cohort) were matched to 54,727 patients without EoE (matched control cohort). During baseline in the full incident EoE cohort, the most common comorbidities within the Charlson Comorbidity Index (CCI) were chronic pulmonary disease (19.79%), hypertension (15.77%), and depression (9.71%); the most common non-CCI comorbidities were reflux esophagitis (38.84%), allergic rhinitis (19.14%), and depression/anxiety (19.07%). During follow-up, the most frequently reported symptoms were acid reflux/heartburn (56.02%), dysphagia (51.89%), and abdominal pain (30.50%). The most common medications first observed were proton pump inhibitors (42.51%) and oral corticosteroids (12.26%). Overall, a larger proportion of the matched incident EoE cohort had visits to any healthcare setting during baseline and follow-up than the matched control cohort. Correspondingly, the annualized, all-cause healthcare costs per patient were higher in the matched incident EoE cohort than in the matched control cohort at baseline (mean (standard deviation), $10,185 ($29,455); median, $3248 vs $4906 ($20,601); $632) and during follow-up ($15,103 ($35,484); $6708 vs $5200 ($21,314); $651).Conclusion: Considerable disease burden is experienced by patients with EoE (before and after diagnosis), which contributes to a high level of HCRU and increased costs.