Disease Burden and Treatment Patterns Associated With Eosinophilic Esophagitis in the United States: A Retrospective Claims Study

Abstract

Goals: This US-based, retrospective claims study aimed to investigate disease burden and treatment patterns in patients with eosinophilic esophagitis (EoE), and to compare health care resource use (HCRU) in patients with EoE and matched controls without EoE.

Materials and methods: Patients with a diagnosis of EoE and ≥12 months of prediagnosis data were identified from the Truven Health MarketScan Research databases (January 2008 to September 2016) and followed up from the diagnosis date until termination of eligibility for a health plan. Patient clinical characteristics and HCRU were recorded in the 12 months before diagnosis; HCRU and treatment patterns were recorded during follow-up. HCRU in patients with EoE and matched controls was compared during the 12-month postdiagnosis period.

Results: Among the 23,003 patients with EoE (mean age: 34.3 y; 64.8% male), gastroesophageal reflux disease was the most common prediagnosis condition (34.6%). 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 on and postdiagnosis) were most frequently to gastroenterologists/pediatric gastroenterologists (49.5% prediagnosis, 72.6% on and postdiagnosis). Inpatient admissions and outpatient and emergency room visits were more likely in patients with EoE than in matched controls (P<0.0001).

Conclusions: Patients with EoE in the USA experience a high disease burden both before and after diagnosis, which requires significant HCRU. Our findings highlight the unmet need for adequate control of EoE-related symptoms.

FIGURE 1

Flowchart for the selection of patients with EoE. EoE indicates eosinophilic esophagitis.

FIGURE 2

Off-label, first-line pharmacotherapy received by patients with EoE on or after diagnosis. *Other treatments included leukotriene antagonists (montelukast sodium) and monoclonal antibodies (ie, omalizumab, mepolizumab, and reslizumab). EoE indicates eosinophilic esophagitis; PPI, proton pump inhibitor; TCS, topical corticosteroids.

FIGURE 3

Number of lines of off-label pharmacotherapy received by patients with eosinophilic esophagitis on or after diagnosis, stratified by age group.

FIGURE 4

Outpatient visits in patients with eosinophilic esophagitis, by specialist.

FIGURE 5

Emergency room visits in patients with eosinophilic esophagitis, stratified by associated diagnosis. GERD indicates gastroesophageal reflux disease.