This retrospective study using administrative claims data examining health care resource utilization (HCRU) found that in the months before a diagnosis of eosinophilic esophagitis (EoE), other diseases were more commonly diagnosed.
Patients with eosinophilic esophagitis (EoE) in the United States have a high burden of disease both before and after diagnosis, requiring a great deal of health care resource utilization (HRCU).
The authors, writing in Journal of Clinical Gastroenterology, said it was the largest population-based study of patients with EoE and that the findings point to EoE's unmet medical needs; while there are clinical guidelines, there are no specific-EoE therapies and what treatment does exist is used off label.
Since studies assessing HCRU and quantifying disease burden are limited and outdated, the authors said the aims of their investigation were to investigate characteristics, HCRU, and treatment patterns before and after an EoE diagnosis and to compare annualized HCRU data in a group of patients with EoE with a matched cohort without EoE.
The 2-phase, retrospective study compared administrative claims data from the Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental databases from January 2008 to September 2016. The databases contain data from over 150 large US employers and about 200 insurance companies.
The study had 2 phases. The phase 1 population included all patients in the database who had at least 2 diagnoses of EoE (using the International Classification of Diseases, Ninth Revision or Tenth Revision, Clinical Modification [ICD-9/10-CM] codes 530.13 [ICD-9-CM] or K20.0 [ICD-10-CM]) documented on different dates.
Phase 1 included data on drug therapy, including off-label use of pharmacotherapies that were considered likely to be used to treat EoE.
In the phase 2 matched cohort study, the EoE population included all patients who met the inclusion criteria for phase 1 and who were continuously enrolled in a health plan for at least 12 months after the index date. Controls without EoE were selected from a 5% random sample in the database. These individuals had no documented diagnosis of EoE.
For both groups, continuous enrollment in a health plan during the 12 months before the matched index date (the preindex period) and for 12 months after the matched index date (the study period) was required.
The 2 cohorts were matched 1:1 by sex, age, geographic region (as of the index date), Charlson comorbidity index classification during the preindex period, and length of continuous enrollment from the eligibility start date to the index date.
HRCU included emergency department (ED) visits, outpatient visits, inpatient visits, and diagnostic endoscopy use in the preindex and follow-up periods. In phase 1, outpatient visits and diagnostic endoscopy use were recorded separately on the index date.
Results showed that of the 23,003 patients with EoE, 64.8% were male, in line with what is already known about EoE. The mean age was 34.3 years.
In the 12 months before an EoE diagnosis was recorded, more than a third of patients (34.6%) were told they had gastroesophageal reflux disease, followed by diagnoses for allergic rhinitis (19.5%), asthma (14.7%), esophageal stricture (11.0%), food impaction (7.8%), eczema (7.2%), and food allergy (4.4%).
Esophageal stricture was more frequently seen in adults 55 years or older (15.4%) and adults aged 18 to 54 years compared with adolescents or children.
After diagnosis, the most common off-label, first-line treatments were proton pump inhibitor monotherapy (52.8%) and topical corticosteroid monotherapy (21.5%). Overall, 3336 patients (14.5%) received at least 3 lines of off-label pharmacotherapy.
Outpatient visits (recorded in 99.9% of patients at and post diagnosis) were most frequently to gastroenterologists/pediatric gastroenterologists (49.5% prediagnosis, 72.6% at and post diagnosis).
Inpatient admissions and outpatient and ED visits were more likely in patients with EoE than in matched controls (P < .0001).
The results show that “real-world treatment patterns vary, and that many patients switch therapy frequently, highlighting the unmet need for adequate control of EoE-related symptoms in clinical practice,” the researchers wrote.
“Treatments specifically formulated for patients with EoE may improve clinical benefits,” the authors concluded. “Further research is required to determine the benefit of existing and new treatments in alleviating the clinical and economic burden of EoE.”
Lu M, Goodwin B, Vera Llonch M, Williams J. Disease burden and treatment patterns associated with eosinophilic esophagitis in the United States a retrospective claims study. J Clin Gastroenterol. 2022;56(2):133-140. doi:10.1097/MCG.0000000000001491