Currently Viewing:
Supplements A Managed Care Perspective:Treatment of Idiopathic Pulmonary Fibrosis
Overview of Idiopathic Pulmonary Fibrosis (IPF) and Evidence-Based Guidelines
Roozbeh Sharif, MD, MEd, MSc
Evaluating New Treatment Options
Steven D. Nathan, MD
Currently Reading
Strategies to Manage Costs in Idiopathic Pulmonary Fibrosis
Gary M. Owens, M
A Managed Care Perspective: Treatment of Idiopathic Pulmonary Fibrosis Post Test

Strategies to Manage Costs in Idiopathic Pulmonary Fibrosis

Gary M. Owens, M
Care management programs are particularly important in the management of chronic conditions such as IPF, where patients have identified a dearth of clear and understandable disease education, comprehensive support, and counseling programs.43 Compliance and adherence are key to the management of these conditions. Forty-six percent of people with chronic conditions do not believe that they receive the treatment they need, and 74% have difficulty obtaining prescription medications.43 Studies have shown that up to 50% of patients with chronic conditions fail to adhere to their prescribed medications despite the effectiveness of the medication on their condition and their quality of life.


IPF is a high-cost disease, and optimizing cost efficiency requires an awareness of the evolving treatment landscape for IPF. Currently, nintedanib and pirfenidone are the only 2 prescription medications approved for treatment of IPF, each at a cost of almost $100,000 per patient per year.44,45 It is highly likely that patients with IPF will be prescribed numerous different drugs in addition to these novel treatments to manage symptoms and comorbidities. This polypharmacy will further increase their prescription costs, adding to the already substantial economic burden associated with IPF. These treatment costs will continue to increase as novel therapeutics are approved and the population ages. It is important for payers to recognize the growing complexity of the management and drug treatment issues surrounding this condition. Care management programs using a team of individuals, such as case managers, clinical pharmacists, and specialty pharmacists, can play a vital role in managing these patients. Frequent contact with the care team and the patient may be useful to monitor for comorbidities and exacerbations, and result in interventions that can decrease emergency department use and hospitalizations. Likewise, medication therapy management programs to help patients with compliance, adherence, and the management of a multidrug regimen can provide essential support to these patients. As the treatment for this complex disease evolves, payers and treating physicians need to find ways to work in concert to improve outcomes.

Author affiliation: President, Gary Owens Associates, Ocean View, Delaware
Funding source: This activity is supported by educational grants from Genentech and Boehringer Ingelheim Pharmaceuticals, Inc.
Author disclosure: Dr Owens has no relevant financial relationships with commercial interests to disclose.
Authorship information: Concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and supervision.
Address correspondence to:
Acknowledgment: Priya H. Karkhanis, MS, provided medical writing and editorial support for this manuscript.
1.         Raghu G, Collard H, Egan J, et al; ATS/ERS/JRS/ALAT Committee on Idiopathic Pulmonary Fibrosis. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788-824. doi: 10.1164/rccm.2009-040GL.
2.         Ley B, Collard HR. Epidemiology of idiopathic pulmonary fibrosis. Clin Epidemiol. 2013;5:483-492. doi: 10.2147/CLEP.S54815.
3.         Frankel SK, Schwarz MI. Update in idiopathic pulmonary fibrosis. Curr Opin Pulm Med. 2009;15(5):463-469. doi: 10.1097/MCP.0b013e32832ea4b3.
4.         Raghu G, Chen SY, Yeh WS, et al. Idiopathic pulmonary fibrosis in US Medicare beneficiaries aged 65 years and older: incidence, prevalence, and survival, 2001-11 [erratum in Lancet Respir Med. 2014;2(7):e12]. Lancet Respir Med. 2014;2(7):566-572. doi: 10.1016/S2213-2600(14)70101-8.
5.         Nalysnyk L, Cid-Rufaza J, Rotella P, Esser D. Incidence and prevalence of idiopathic pulmonary fibrosis: review of the literature. Eur Respir Rev. 2012;21(126):355-361. doi: 10.1183/09059180.00002512.
6.         Olson AL, Swigris JJ, Lezotte DC, Norris JM, Wilson CG, Brown KK. Mortality from pulmonary fibrosis increased in the United States from 1992 to 2003. Am J Respir Crit Care Med. 2007;176(3):277-284. doi: 10.1164/rccm.200701-044OC.
7.         Ley B, Collard HR, King TE Jr. Clinical course and prediction of survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;183(4):431-440. doi: 10.1164/rccm.201006-0894CI.
8.         Mannino DM, Etzel RA, Parrish RG. Pulmonary fibrosis deaths in the United States, 1979-1991. an analysis of multiple-cause mortality data. Am J Respir Crit Care Med. 1996;153(5):1548-1552. doi: 10.1164/ajrccm.153.5.8630600.
9.         Collard HR, Chen SY, Yeh WS, et al. Health care utilization and costs of idiopathic pulmonary fibrosis in U.S. Medicare beneficiaries aged 65 years and older. Ann Am Thorac Soc. 2015;12(7):981-987. doi: 10.1513/AnnalsATS.201412-553OC.
10.      Collard HR, Ward AJ, Lanes S, Courtney Hayflinger D, Rosenberg DM, Hunsche E. Burden of illness in idiopathic pulmonary fibrosis. J Med Econ. 2012;15(5):829-835. doi: 10.3111/13696998.2012.680553. 
11.      De Guzman J. FDA approves two drugs (Esbriet, Ofev) for treating fatal lung disease. Capital OTC. October 16, 2014. Accessed May 17, 2017.
12.      Chen SY, Collard HR, Yeh WS, et al. An analysis of US Medicare beneficiaries: burden of direct medical costs in patients with idiopathic pulmonary fibrosis. PRS26. Presented at ISPOR 17th Annual European Congress Research Abstracts. November 8-12, 2014, Amsterdam, The Netherlands. Accessed May 17, 2017.
13.      Yu YF, Wu N, Chuang CC, et al. Patterns and economic burden of hospitalizations and exacerbations among patients diagnosed with idiopathic pulmonary fibrosis. J Manag Care Spec Pharm. 2016;22(4):414-423. doi: 10.18553/jmcp.2016.22.4.414.
14.      Lee AS, Mira-Avendano I, Ryu JH, Daniels CE. The burden of idiopathic pulmonary fibrosis: an unmet public health need. Respir Med. 2014;108(7):955-967. doi: 10.1016/j.rmed.2014.03.015.
15.      Juarez MM, Chan AL, Norris AG, Morrissey BM, Albertson TE. Acute exacerbation of idiopathic pulmonary fibrosis—a review of current and novel pharmacotherapies. J Thorac Dis. 2015;7(3):499-519. doi: 10.3978/j.issn.2072-1439.2015.01.17.
16.      Agarwal R, Jindal SK. Acute exacerbation of idiopathic pulmonary fibrosis: a systematic review. Eur J Intern Med. 2008;19(4):227-235. doi: 10.1016/j.ejim.2007.04.024.
17.      Song JW, Hong SB, Lim CM, Koh Y, Kim DS. Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J. 2011;37(2):356-363. doi: 10.1183/09031936.00159709.
18.      Mollica C, Paone G, Conti V, et al. Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis. Respiration. 2010;79(3):209-215. doi: 10.1159/000225932.
19.      Daniels C, Yi ES, Ryu JH. Autopsy findings in 42 consecutive patients with idiopathic pulmonary fibrosis. Eur Respir J. 2008;32(1):170-174. doi: 10.1183/09031936.00176307.
20.      Pashinsky YY, Jaffin BW, Litle VR. Gastroesophageal reflux disease and idiopathic pulmonary fibrosis. Mt Sinai J Med. 2009;76(1):24-29. doi: 10.1002/msj.20088. 
21.      Ryerson CJ, Arean PA, Berkeley J, et al. Depression is a common and chronic comorbidity in patients with interstitial lung disease. Respirology. 2012;17(3):525-532. doi: 10.1111/j.1440-1843.2011.02122.x.
22.      King C, Nathan SD. Identification and treatment of comorbidities in idiopathic pulmonary fibrosis and other fibrotic lung diseases. Curr Opin Pulm Med. 2013;19(5):466-473. doi: 10.1097/MCP.0b013e328363f460.
23.      Lancaster LH, Mason WR, Parnell JA, et al. Obstructive sleep apnea is common in idiopathic pulmonary fibrosis. Chest. 2009;136(3):772-778. doi: 10.1378/chest.08-2776.
24.      Hubbard R, Venn A, Lewis S, Britton J. Lung cancer and cryptogenic fibrosing alveolitis. a population-based cohort study. Am J Respir Crit Care Med. 2000;161(1):5-8. doi: 10.1164/ajrccm.161.1.9906062.
25.      Tomassetti S, Gurioli C, Ryu JH, et al. The impact of lung cancer on survival of idiopathic pulmonary fibrosis. Chest. 2015;147(1):157-164. doi: 10.1378/chest.14-0359.
26.      Sprunger DB, Olson AL, Huie TJ, et al. Pulmonary fibrosis is associated with an elevated risk of thromboembolic disease. Eur Respir J. 2012;39(1):125-132. doi: 10.1183/09031936.00041411.
27.      Fulton BG, Ryerson CJ. Managing comorbidities in idiopathic pulmonary fibrosis. Int J Gen Med. 2015;8:309-318. doi: 10.2147/IJGM.S74880.
28.      Fleetwood K, McCool R, Glanville J, et al. Systematic review and network meta-analysis of idiopathic pulmonary fibrosis treatments. J Manag Care Spec Pharm. 2017;23(3-b suppl):S5-S16. doi: 10.18553/jmcp.2017.23.3-b.s5.
29.      Fisher M, Nathan SD, Hill C, et al. Predicting life expectancy for pirfenidone in idiopathic pulmonary fibrosis. J Manag Care Spec Pharm. 2017;23(3-b suppl):S17-S24. doi: 10.18553/jmcp.2017.23.3-b.s17.
30.      Ofev [prescribing information]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals; 2017.
31.      Esbriet [prescribing information]. South San Francisco, CA: Genentech, Inc; 2017.
32.      Idiopathic Pulmonary Fibrosis Clinical Research Network; Raghu G, Anstrom KJ, et al. Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med. 2012;366(21):1968-1977. doi: 10.1056/NEJMoa1113354.
33.      Kolb M, Richeldi L, Behr J, Anstrom KJ, Glazer C; IPFnet investigators. Nintedanib in patients with idiopathic pulmonary fibrosis and preserved lung volume. Thorax. 2017;72(4):340-346. doi: 10.1136/thoraxjnl-2016-208710.
34.      Collard HR, Yow E, Richeldi L, Anstrom KJ, Glazer C; IPFnet Investigators. Suspected acute exacerbation of idiopathic pulmonary fibrosis as an outcome measure in clinical trials. Respir Res. 2013;14:73. doi: 10.1186/1465-9921-14-73.
35.      Behr J, Kreuter M, Hoeper MM, et al. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry. Eur Respir J. 2015;46(1):186-196. doi: 10.1183/09031936.00217614.
36.      Ryerson CJ, Hartman T, Elicker BM, et al. Clinical features and outcomes in combined pulmonary fibrosis and emphysema in idiopathic pulmonary fibrosis. Chest. 2013;144(1):234-240. doi: 10.1378/chest.12-2403.
37.      Wuyts WA, Peccatori FA, Russell AM. Patient-centred management in idiopathic pulmonary fibrosis: similar themes in three communication models. Eur Respir Rev. 2014;23(132):231-238. doi: 10.1183/09059180.00001614.
38.      Annis AM, Holtrop JS, Tao M, Chang HC, Luo Z. Comparison of provider and plan-based targeting strategies for disease management. Am J Manag Care. 2015;21(5):344-351.
39.      Disease Management Programs: Improving health while reducing costs? Georgetown University Health Policy Institute. Issue Brief 4. January 2004.
40.      Duck A, Pigram L, Errhalt P, Ahmed D, Chaudhuri N. IPF Care: a support program for patients with idiopathic pulmonary fibrosis treated with pirfenidone in Europe. Adv Ther. 2015;32(2):87-107. doi: 10.1007/s12325-015-0183-7.
41.      Chaudhuri N, Duck A, Frank R, Holme J, Leonard C. Real world experiences: pirfenidone is well tolerated in patients with idiopathic pulmonary fibrosis. Respir Med. 2014;108(1):224-226. doi: 10.1016/j.rmed.2013.11.005.
42.      Patel BN, Audet PR. A review of approaches for the management of specialty pharmaceuticals in the United States. Pharmacoeconomics. 2014;32(11):1105-1114. doi: 10.1007/s40273-014-0196-0.
43.      Chronic Conditions: Making the case for ongoing care. September 2004 update. Johns Hopkins University, Partnership for Solutions. Accessed May 17, 2017.
44. Esbriet Prices, Coupons and Patient Assistance Programs. Accessed May 8, 2017.
45. Ofev Prices, Coupons and Patient Assistance Programs. Accessed May 8, 2017.
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up

Sign In

Not a member? Sign up now!