P0393 - Time on Treatment, Healthcare Resource Utilization, and Costs Associated with Topical Corticosteroids and Proton Pump Inhibitors in Patients with Eosinophilic Esophagitis in the United States

Ellen Qian, MPH¹, Ye Wang, PhD¹, Ashish S. Pople, ², Mousumi Biswas, MPH¹, Evan S. Dellon, MD, MPH^3
1Bristol Myers Squibb, Princeton, NJ; ²Mu Sigma, Bengaluru, Karnataka, India; ³University of North Carolina School of Medicine, Chapel Hill, NC

Introduction: In the US, proton pump inhibitors (PPI) and topical corticosteroids (TCS) are commonly used (off label) for patients with eosinophilic esophagitis (EoE). This study assessed time on treatment (ToT), healthcare resource utilization (HCRU) and costs associated with these treatments.

Methods: A retrospective observational study was conducted using the IQVIA® PharMetrics+® database (1/1/2009–‍6/30/2022) to identify patients with ≥2 EoE diagnostic claims and ≥1 pharmacy claim for PPI, TCS, or PPI+TCS as first line of therapy (LOT1). The LOT1 index date was their 1^st pharmacy claim on/after 1^st EoE diagnosis. If patients switched to second line of therapy (LOT2), the LOT2 index date was their 1^st pharmacy claim after switching from LOT1. Continuous enrollment for ≥12 months pre- and post-index date was required. Follow-up time was 12 months after index or until a censoring event (treatment discontinuation, switching, or death/disenrollment). Inverse-probability of treatment weighting (IPTW) was used to balance covariates across treatment cohorts. ToT was reported, and Cox regressions were used to estimate IPTW-adjusted hazard ratios (aHRs) for time to treatment modification (switches or discontinuations). After IPTW adjustment, generalized linear models were applied to evaluate all-cause and EoE-related HCRU and medical costs.

Results: 44,464 patients with EoE were assessed, 61.0%, 20.9%, and 18.1% received PPI, TCS, and PPI+TCS, respectively, as LOT1 (Table). 11,587 (26.1%) patients switched to LOT2 (Table; PPI: 48.1%, TCS: 23.3%, and PPI+TCS: 28.5%). Adjusted median [interquartile range] ToT in LOT1 and LOT2 was longest for PPI (7.7 [3.9–12.0] and 5.8 [3.0–12.0] months, respectively) followed by TCS (3.9 [3.9–5.9] and 3.9 [1.8–4.9] months) and PPI+TCS (3.0 [1.7–4.5] and 2.8 [1.6–4.3] months). Compared with PPI, aHRs (95% CI) for treatment modification for TCS were 2.4 (2.3–2.5) and 2.1 (2.0–2.2) for LOT1 and LOT2, and for PPI+TCS were 4.5 (4.4–‍4.6) and 2.8 (2.7–3.0), respectively (all P < 0.0001). In both lines of therapy, IPTW-adjusted all-cause and EoE-related HCRU and costs were lowest with PPI, followed by TCS and PPI+TCS (see Figure).

Discussion: Compared with PPI monotherapy, TCS alone or in combination with PPI in LOT1 or LOT2 were associated with shorter ToT, higher risk of treatment modifications, and higher all-cause and EoE-related HCRU and costs. These findings suggest a need for targeted therapies that offer more durable symptomatic relief and effectively reduce cost burden.




Disclosures:


Ellen Qian, MPH¹, Ye Wang, PhD¹, Ashish S. Pople, ², Mousumi Biswas, MPH¹, Evan S. Dellon, MD, MPH³. P0393 - Time on Treatment, Healthcare Resource Utilization, and Costs Associated with Topical Corticosteroids and Proton Pump Inhibitors in Patients with Eosinophilic Esophagitis in the United States, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.