Healthcare Resource Utilization and Medical Costs

Data regarding the burden of IPF on healthcare resource utilization are limited.46 However, several retrospective studies have demonstrated that IPF is associated with higher medical costs, hospital admission rates, and outpatient visits compared to age- and gender-matched control patients.47484950 While the cost of care for patients with IPF is already high, it is predicted that this cost will increase in the future as IPF becomes more widely diagnosed, and if the trend of increased hospital admission rates for patients with IPF continues.4648

Overall Medical Costs Associated with IPF

Harold Collard and colleagues designed a retrospective study to evaluate the burden of illness associated with IPF, including healthcare resource utilization and costs. Patients were retrospectively identified from United States claims databases over a 7.5-year period ending in September 2008.47 In this study, the average direct medical costs for a patient with IPF were $26,378 per person-year as compared to $14,254 for age- and gender-matched control subjects (Figure 1).47 Outpatient medication costs were two-fold higher in patients with IPF, and the costs associated with inpatient and outpatient services were nearly two-fold higher (1.78 and 1.76 times, respectively).

Figure 1.
Direct medical costs per person-year including medication claims, inpatient services, and outpatient services. Control patients were age-and gender-matched. Used with permission from Collard HR et al. J Med Econ. 2012;15:829-835.

IPF Patient vs. Control Group Direct Medial Costs Comparison Chart

Healthcare Resource Utilization

In the retrospective study by Collard et al discussed above, nearly all patients with IPF underwent pulmonary function testing during the study period, and approximately half had a CT scan of the thorax (Table 1).47 Fewer patients were subjected to the 6-minute walk test or had measurements of arterial blood gases taken; however, these tests were still performed significantly more frequently in patients with IPF than in control subjects.47

Table 1.
Healthcare resource utilization rates (post-index per person-year).a Adapted from Collard HR et al.47

Healthcare Resource Post-index Utilization
  IPF Control Rate ratio (95% CI)
All-cause hospitalization (# of admissions) 0.529 0.268 1.97 (1.90-2.05)b
Outpatient services      
Office visits (including specialist) and ER 27.682 14.272 1.94 (1.93-1.95)b
Pulmonary disease specialist visit 2.097 0.207 10.14 (9.77-10.52)b
Procedures/Tests      
6MWT 0.109 0.005 21.97 (17.42-27.70)b
Pulmonary function tests 0.938 0.071 13.20 (12.40-14.04)b
Arterial blood gases 0.062 0.007 8.8 (7.20-10.76)b
Computed tomography of thorax 0.488 0.096 5.07 (4.80-5.37)b

aValues shown as per person-year.
bp-value <0.0001
6MWT, 6-minute walk test; ER, emergency room.

Patients with IPF have high all-cause and IPF-related hospital admission rates. In the same study by Collard et al, approximately 35% of patients with IPF were hospitalized over a 6-month pre-index period compared to less than 10% of age- and gender-matched control subjects.47 During this same period, 14% of patients had at least one IPF-related hospitalization event, defined as hospitalization with a primary diagnosis of idiopathic fibrosing alveolitis (IFA) or a primary diagnosis of respiratory failure with a secondary diagnosis of IFA.47 During the one-year period following IPF diagnosis, all-cause hospital admission and outpatient visit rates were nearly two-fold higher in patients with IPF (Table 2).47

A series of studies by Wu, Yu, and colleagues evaluated the healthcare resource utilization by patients with IPF, including the frequency, duration, and costs associated with hospitalization and acute exacerbation during a 1-year period following diagnosis.495051 Patients were retrospectively identified from the PharMetrics Integrated Database (IMS Lifelink) from 2006-2011. In this study, there were a total of 1,174 hospitalizations among the 1,735 patients identified (Table 3)51. Among the identified patients, 38.6% had one or more all-cause hospitalizations, 10.8% had one or more IPF-related hospitalizations, and 4.6% had one or more suspected acute exacerbation of IPF leading to hospitalization.50 Utilization rates were consistently significantly higher in patients with IPF than matched controls in all areas studied both prior to and following adjustment for length of follow-up, including hospitalization, ER visits, and physician and pulmonologist visits (Table 2)49 Remarkably, hospitalizations, ER visits, and outpatient hospital, physician, and pulmonologist visits were the highest in the periods immediately prior to and immediately following diagnosis.49

Table 2.
Adjusted distribution of healthcare resource utilization 1 year post-index. Data are presented as mean number of services per person-year. Adapted from Wu N et al.49

  Adjusted Healthcare Resource Utilization, Mean (95% CI)a
  IPF patients Non-IPF members Marginal differenceb
Days in hospital 5.3 (4.8-5.8) 2.8 (2.5-3.0) 2.5 (2.0-3.1)
Hospitalizations 0.63 (0.58-0.66) 0.31 (0.29-0.33) 0.32 (0.26-0.35)
ER visits 0.62 (0.58-0.66) 0.48 (0.46-0.50) 0.14 (0.09-0.18)
Outpatient hospital visits 5.7 (5.4-5.9) 3.1 (2.9-3.2) 2.6 (2.3-2.9)
Physician office visits 12.9 (12.6-13.1) 8.4 (8.3-8.6) 4.4 (4.1-4.7)
Pulmonologist visits 2.0 (2.0-2.1) 0.1 (0.1-0.1) 1.9 (1.9-2.0)
Combined chest x-rays/CT scans 3.6 (3.4-3.8) 2.3 (2.0-2.6) 1.3 (1.1-1.5)

aValues adjusted for different lengths of follow-up among IPF patients and non-IPF members. Adjustment based on generalized linear models controlling for patient demographics, comorbidities, and other relevant covariates.
bMarginal difference between IPF patients and non-IPF members was significantly different from 0 at p<0.05 if its confidence interval does not include 0.

Similar trends are seen in Europe as demonstrated by a study carried out by Vidya Navaratnam and colleagues in 2013.48 The authors of this study utilized the Hospital Episode Statistics database containing information about hospital admissions to National Health Service hospitals in England from 1998-2010. Patients with IPF were retrospectively identified to analyze admission rates, length of stay, and costs associated with inpatient care. In this study, the authors found that as the number of incident cases of IPF rose, the rate of hospital admissions also increased.48 The estimated annual cost associated with inpatient care (N=9,525 hospital admissions) was over 16 million pounds between 2009 and 2010 (approximately 24 million dollars).48 According to the most recent data from the United States Department of Health and Human Services, 5,255 patients were hospitalized for IPF-related incidents in 2012, defined as hospitalization with a primary diagnosis of idiopathic pulmonary fibrosis (ICD-9 code 516.31).52

Table 3.
Frequency, duration, and costs associated with hospitalization events among patients with IPF, including patients with suspected acute exacerbation, during the 1-year post-index period.a Adapted from Yu Y et al. Presented at the American Thoracic Society Annual Meeting; May 16-21, 2014; San Diego, CA.

Total (N=1735) All-cause hospitalizations IPF-related hospitalizations Suspected exacerbation requiring hospitalization Suspected exacerbations NOT requiring hospitalization
Patients with events, n (%) 669 (38.6) 188 (10.8) 79 (4.6) 1,251 (72.1)
Number of events within 1 year 1,174 234 102 3,903
Overall rate, per person/year (95% CI) 0.83 (0.79, 0.88) 0.17 (0.14, 0.19) 0.07 (0.06, 0.09) 2.77 (2.69, 2.86)
Rate among patients with events, per person/year (95% CI) 2.28 (2.15, 2.41) 1.74 (1.51, 1.96) 1.68 (1.36, 2.01) 3.65 (3.54, 3.77)
Days in hospital per event        
Mean (SD) 9 (11) 8 (10) 6 (7) NA
Median (25th – 75th percentile) 5 (3, 11) 5 (3, 9) 4 (3,8) NA
Costs per event, $b        
Mean (SD) 13,987 (41,988) 16,812 (66,399) 14,731 (85,468) 444 (1481)
Median (25th – 75th percentile) 4,690 (1158, 12,108) 3,914 (1469, 12,096) 2,213 (1469, 6657) 176 (96, 380)

aMedicare patients were under-represented in the database utilized for this retrospective study.
bCosts include insurers’ payment and patients’ out-of-pocket costs.
NA, not applicable.

The mean cost of hospitalization ranged from $13,987 to $16,812 per stay in insurers’ payments and patients’ out-of-pocket costs. In this study population, all-cause hospitalization among patients with IPF was estimated to cost $16.4 million.51 IPF-related hospitalization was estimated to cost $3.9 million, while suspected exacerbations requiring hospitalization cost $1.5 million.

In addition, more than 70% of patients experienced a suspected acute IPF exacerbation leading to urgent outpatient visits, costing an average of $444 per visit. Nearly 4,000 suspected exacerbations were identified among the patients during the 1-year study period, with a total cost of $1.7 million.47

Summary

The direct medical costs for a patient with IPF are nearly two-fold greater than the costs associated with caring for age- and gender-matched control patients.47 Hospital admission rates and outpatient visit rates are nearly two-fold higher, with the average cost of hospitalization ranging from $14,000 to $17,000 per event.51 In addition, the costs associated with acute exacerbation of IPF are also high, particularly if hospitalization is required.51