Idiopathic pulmonary fibrosis (IPF) is a chronic, incurable lung disease characterised by progressive lung function decline and a poor prognosis with a median survival time of 3–4 years. In posthoc analyses of placebo-controlled studies, the tyrosine kinase inhibitor nintedanib consistently slowed down lung function decline by about 50% among patients with preserved or reduced lung function. However, there is an ongoing debate on when to initiate treatment in a real-life setting. Therefore, an analysis presented during the ATS meeting assessed medical costs and risk of hospitalisation among patients with IPF by timing of nintedanib initiation within 12 months after diagnosis [1].
This observational study included administrative claims data on insured patients aged ≥40 years with ≥2 medical claims with an IPF diagnosis on separate dates from 01 October 2014 – 30 June 2019. All patients had to be enrolled for 6 months before IPF diagnosis and up to 13 months after for cost analysis or 12 months after for hospitalisation analysis. Data was analysed retrospectively on all-cause 12-month medical costs and all-cause follow-up hospitalisation. As information such as forced vital capacity value is not readily available in claims data, proxies (e.g. oxygen use) were utilised as markers for disease severity. Study cohorts were analysed according to time from IPF diagnosis to treatment initiation (1; 2–3; 4–6; or 7–12 months).
The study sample consisted of 449 patients with a mean age of 72 years, most were male (68%), as expected in an IPF population. Baseline all-cause medical utilisation and associated costs were comparable between cohorts. Adjusted 12-month medical costs and adjusted all-cause hospitalisation risk differed by the timing of nintedanib initiation (P=0.020 and P<0.001, respectively). All-cause hospitalisation risk was significantly higher among patients who were not yet treated versus patients treated before the end of months 2–3 (P=0.026), 4–6 (P=0.014), and 7–12 (P< 0.001).
In addition, 12-month medical costs were 69% higher for patients who initiated treatment in months 2–3 versus month 1. Costs were numerically higher but not statistically different for patients starting therapy in months 4–6 and 7–12 versus month 1.
The authors concluded that initiating therapy soon after the IPF diagnosis may have reduced the hospitalisation risk and was associated with lower medical costs. The reason for the benefit of early treatment might be due to the preservation of lung function in IPF, which translates into a measurable real-world benefit.
- Singer D, et al. Impact of timing of nintedanib initiation among patients newly diagnosed with idiopathic pulmonary fibrosis. Session TP15: Diffuse parenchymal lung diseases: ILD, sarcoidosis, IPF, LAM, ATS 2021 International conference, 14-19 May 2021.
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