The Economic Burden of Eosinophilic Gastritis and Eosinophilic Enteritis in the United States

Abstract

Introduction: Eosinophilic gastritis and eosinophilic enteritis (EoG/EoN) are associated with a substantial clinical burden. However, limited information is available regarding the economic burden of EoG/EoN. This study was conducted to compare healthcare resource use (HRU) and costs among patients with EoG/EoN versus without EoG/EoN in the USA.

Methods: Administrative claims data from the IBM MarketScan^® Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Benefits Databases (2009-2019) was used to identify two cohorts of patients. Patients without EoG/EoN were matched 3:1 to patients with EoG/EoN on sex, year of birth, and healthcare plan type. Study measures included demographic characteristics, select comorbidities, all-cause HRU, and costs. Comparisons were made over a 1-year period following EoG/EoN diagnosis for patients with EoG/EoN and an eligible date for patients without EoG/EoN.

Results: A total of 2219 patients with EoG/EoN and 6657 patients without EoG/EoN were analyzed. Significantly higher proportions of patients with EoG/EoN versus without EoG/EoN had comorbid conditions. Rates of all-cause HRU were significantly higher among patients with EoG/EoN versus patients without EoG/EoN (adjusted rate ratio [95% confidence interval]: inpatient visits, 6.26 [5.26, 7.46]; outpatient visits, 1.17 [1.16, 1.19]; emergency department visits, 2.11 [1.98, 2.25]; all p < 0.001). Patients with EoG/EoN incurred significantly higher costs versus patients without EoG/EoN (adjusted mean cost difference $31,180; p < 0.001). Cost differences were largely due to outpatient (adjusted mean cost difference $14,018; p < 0.001) and inpatient (adjusted mean cost difference $11,224; p < 0.001) costs.

Conclusion: The economic burden associated with EoG/EoN is substantial, with patients with EoG/EoN having a higher rate of HRU and incurring $31,180 more than patients without EoG/EoN on average. Most of the cost difference was attributable to outpatient and inpatient costs. Cost-saving strategies to lower the burden of illness in this patient population are needed.

Keywords: Economic burden; Eosinophilic enteritis; Eosinophilic gastritis; Healthcare resource utilization.

Fig. 1

Sample selection of patients with and without EoG/EoN. EoG eosinophilic gastritis, EoN eosinophilic enteritis, EoE eosinophilic esophagitis, IBS irritable bowel syndrome, N number. ^aControls were matched to patients with EoG/EoN 10:1 on sex, year of birth, and capitated/non-capitated plan type. Controls were also required to have at least 18 months of continuous enrollment, with at least 1 day in the calendar year of the matched patient's first diagnosis with EoG/EoN and were not allowed to have a diagnosis of functional dyspepsia or IBS. ^bFor patients with EoG/EoN, the index date was a randomly selected date with a diagnosis code for EoG/EoN that allowed for 6 months of continuous enrollment prior to the index date (baseline) and 12 months of continuous enrollment after the index date (study period). For patients without EoG/EoN, the index date was a date that met the baseline and study period criteria and was closest to the case index date. ^c2145 cases were lost because of a lack of at least 18 months of continuous eligibility and 15 cases were lost because of a lack of at least one eligible matched control. ^d6241 controls were lost because of a lack of at least 18 months of continuous eligibility and 18,124 controls were lost because of a lack of at least one eligible matched case. ^eControls were matched to cases using a 3:1 ratio to create the final sample. When a case had more than 3 eligible matched controls, the 3 controls with an index date closest to the matched case’s index date were selected

Fig. 2

Adjusted all-cause healthcare costs during the 12-month study period^a–c. EoG eosinophilic gastritis, EoN eosinophilic enteritis. ^aThe 12-month study period was defined as the period following and including the index date. ^bAdjusted results were estimated using generalized estimating equations with a Tweedie distribution. The adjusted models controlled for the following: age at index date, sex, region, index year and plan type. ^cAll costs were inflated to 2021 USD