Gary L. Johnson, MD, MBA: This is not a particularly big focus for health plans. It’s a relatively rare disease; my understanding about 20 per 100,000. So the numbers are relatively small, although the costs per patient are fairly high, can be fairly high, but it is not something that we focus on, primarily because there’s not any particular interventions that we can do to alter those costs.
Alicia M. Hinze, MD: Some of the direct costs that can be associated with interstitial lung disease would be clinic appointments, going to see the doctor frequently, especially as we’re determining whether there’s been progression or stability. Patients perhaps with more progressive interstitial lung disease, if they develop any exacerbations, then hospital costs can certainly occur. Other costs involved in evaluating and managing interstitial lung disease would be monitoring with imaging, for example, so high resolution CTs, monitoring with pulmonary function testing. So those are some of the direct costs, as well as medication therapies, so whether that be immunosuppressant therapies or some of the relatively newer antifibrotic therapies that can be used in more of the idiopathic pulmonary fibrosis, that’s where the approval has been.
Indirect costs can be related to lost work. So, if patients are hospitalized because of exacerbation of interstitial lung disease, then they’re losing time from work. In patients that maybe are dyspneic or very short of breath, for example, they may either have to have a reduced workload or have an alteration, or change in their job functions, or be unable to work really a full-time shift, for example. So some of those would be the indirect costs that we could see.
Costs do increase as severity of disease increases. So, in a patient that really is not experiencing progression of disease, they may not require medication therapy. We may be able to monitor them less, depending on kind of the stage of disease and the characteristics of the interstitial lung disease, so those that simply don’t progress versus those who do progress. We will probably see these patients a little bit more frequently. We may monitor them with pulmonary function tests, for example, or high resolution CTs to evaluate progression of disease, especially for implementing therapies. We certainly want to know that these therapies are working for the patient. In those with progressive lung disease, we will see increase costs in association with appropriate monitoring.
Gary L. Johnson, MD, MBA: In terms of comorbid conditions, those clearly add additional costs, both, again, direct and indirect costs. The more healthcare resources that are utilized to treat those costs add to the direct costs, and also contribute to the indirect costs.
It’s difficult to, to know how many people are misdiagnosed. It’s just something that you can’t really measure. There’s diagnosis of commission where somebody is diagnosed that really doesn’t have ILD, and I’m sure there are many more with other diseases that mimic ILD that really have ILD.
So the bottom line is it’s difficult to know how many people are misdiagnosed, either missing the diagnosis or diagnosed that don’t have the disease. That’s where our prior authorizations come in for the expensive drugs that are used to treat this. It’s our obligation to try to ensure that the drugs that are approved and used for ILD, that the patient actually has the disease.