IPF Carries ‘Substantial Economic Burden’ in US, Study Reports

Idiopathic pulmonary fibrosis (IPF) is associated with a substantial economic burden in the United States, especially for patients who require hospitalization, intensive care, or a lung transplant, a study based on registry data reported.

Annual average costs for 3.9 days in a hospital by patients in this study was put at $13,795, and at $254,417 for those undergoing a transplant (an average hospital stay of 17.9 days).

More work is needed to identify factors driving hospital and treatment costs for IPF patients, its researchers said.

The study, “Hospital-Based Resource Use and Costs Among Patients With Idiopathic Pulmonary Fibrosis Enrolled in the Idiopathic Pulmonary Fibrosis Prospective Outcomes (IPF-PRO) Registry,” was published in the CHEST journal.

IPF is a chronic, progressive disease, and previous research has shown it have a heavy disease burden, as well as high rates of co-existing conditions (comorbidities) and health resource use. Costs were found to be mostly associated with hospitalizations and outpatient care.

To estimate hospital-related use and costs, researchers analyzed data on adults with IPF who enrolled in the national Idiopathic Pulmonary Fibrosis Prospective Outcomes (IPF-PRO) registry (NCT01915511).

This ongoing, U.S.-based registry compiles data on people recently diagnosed with IPF or whose disease was confirmed at one of the 45 enrolling U.S. centers in the previous six months. Its goal is to gather insights into the disease and patients’ treatment course.

“Although there are active registries assessing the burden of IPF in other countries, no recent prospective observational studies, to the best of our knowledge, have specifically evaluated the economic burden of IPF in the United States,” the researchers wrote.

Data covering 300 patients, enrolled in IPF-PRO between June 2014 and April 2016, were analyzed. Patients’ mean age was 69, most were male (75%), and white (95%). About two-thirds (64%) had commercial health insurance, and 33% were on Medicare.

Patients forced vital capacity (FVC) and diffusing lung capacity for carbon monoxide (Dlco) — two measures of lung function that typically decline as disease progresses — were 50% to 80% FVC predicted, and 30% to 89% DLco predicted at baseline (at the time of their start in this registry study). Most are current or former smokers.

Comorbidities in the group included coronary artery disease, sleep apnea, diabetes, and emphysema.

At enrollment, 55% of these patients were receiving antifibrotic treatment, and 26% were not on any treatment. About 35% were using supplemental oxygen.

Data one year later — among those with a complete 12-month follow-up — found 228 of these people alive, 30 deaths, and nine who underwent a transplants. Six had withdrawn from the study, and others were lost during follow-up.

The probability of hospitalization was 18.1% at six months and 30.2% at 12 months, and highest for those with FVC lower than 50% predicted, those with Dlco less than 30% predicted, and those needing supplemental oxygen for activities and while  at rest.

During the first year of follow-up, researchers registered a total of 158 confirmed hospital visits by 101 patients, with 33 of them emergency department visits. Ten patients accounted for 39 visits, with the majority (63 patients, about 62%) going to the hospital once.

Most (71%) inpatient admissions started with an emergency room visit, and, of those, 69% were admitted. One-fifth (19%) of these hospitalized patients were treated in the intensive care unit (ICU).

Costs for inpatient care were about $13,975 per patient per year. Of this amount, $10,098 was associated with hospitalizations involving ICU admission.

Excluding transplants, the cost of inpatient admissions was an average of $13,795, and associated with a mean hospital stay of 3.9 days.

Hospitalizations related to respiratory problems were more costly that hospitalizations for other reasons, $15,631 versus $12,963, excluding transplants, the study reported.

“The mean cost per hospital admission tended to be higher for participants with more severe disease at baseline (e.g., those requiring supplemental oxygen with activity, those with poorer lung function, those with a history of all-cause or respiratory-related hospitalization),” the researchers wrote. But data were highly variable, they added.

For the nine enrolled patients (3%) who had lung transplants, hospital stays were on average four times longer (17.9 days) than among other hospitalized patients. Stays in ICU were almost 15 times longer (7.3 vs. 0.5 days), and hospitalization costs per stay were almost 20 times higher ($254,417 vs. $13,795).

These results confirm that “IPF is associated with a substantial economic burden incurred by patients requiring hospital care,” the researchers wrote.

The team acknowledged some limitations to their study, including assessment of costs from a hospital’s perspective, which may not reflect costs given to a third-party payer. Costs may also be higher than those reported, as bill collection could be incomplete.

“Further research is warranted to further assess the observed associations with adjustment for relevant covariates and characterize factors driving hospital-based costs in this population,” the researchers concluded.