The high cost of IPF therapies linked to the “substantial economic burden” in the study


Interstitial lung disease (IPD), particularly idiopathic pulmonary fibrosis (IPF), is associated with a substantial economic burden on health systems due to the high cost of their treatments, according to a German study.

The cost of drugs for patients with IPF, recruited between November 2016 and April 2017 and followed for one year, fell from € 1,442 (approximately $ 1,690) to € 11,000 (approximately $ 12,888), with the therapies anti-fibrotic drugs Esbriet (pirfenidone) and Ofev (nintedanib) accounting for nearly 85% of the total costs of LTD drugs.

Additional disorders, or co-morbidities, and the duration of the illness were factors behind this increase in costs, supporting the need for approaches that could lessen their impact on health systems, its researchers wrote.

The study “Cost factors in the pharmacological treatment of interstitial lung disease»Was published in the journal Respiratory research.

IPF belongs to a family of PGD widely characterized by scarring, or fibrosis, of lung tissue, which decreases lung function over time.

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Current ILD therapies focus primarily on relieving symptoms and stabilizing the disease by controlling inflammation and stopping scarring in the lungs. Since LTDs are generally chronic and progressive disorders, patients are dependent on drugs and frequently use health services, which can result in significant economic burden.

A group of researchers in Germany evaluated drug costs and the factors associated with those costs in LTD patients by analyzing data from the observational study Health Care in ILD Outpatient Visitors (HILDA).

The study, which enrolled 271 patients, collected information about their treatments before enrollment (baseline) and at six-month and 12-month follow-up intervals after enrollment.

Each drug has been classified either as related to DLI – which includes immunosuppressants, steroids, Esbriet by Genentech and Ofev by Boehringer Ingelheim – or as an “other” category.

Of these 271 people, 72 suffered from IPF, 32 suffered from progressive fibrosing PID and 45 suffered from sarcoidosis, a disease characterized by an overactive immune system, resulting in the formation of small clumps of inflammatory cells. The remaining 122 patients had various other forms of LTD.

Most of them were men who had never smoked. The onset and duration of the disease differed between these groups of patients. People with sarcoidosis had the longest duration of illness, on average 8.1 years, while those with IPF had the shortest duration, on average 2.4 years; patients with sarcoidosis were the youngest group, with an average age of 52 years, while patients with IPF were the oldest, with an average of 71.3; and patients with sarcoidosis had the fewest comorbidities, an average of 2.4 other disorders, while patients with IPF had the most, an average of 3.8 comorbidities.

Patients with progressive fibrosing PID were similar to those with sarcoidosis in these measures.

Steroids were the treatment of choice for the majority of non-IPF patients (52.5% at baseline), followed by immunosuppressants (33.1% at baseline). A smaller group, 19.5% of patients, were taking a combination of steroids and immunosuppressants.

At the start of the study and up to six months of follow-up, one in five patients with IPF (20.8%) was being treated with Esbriet or Ofev. At the end of the study, all were being treated with one of these two drugs. A small group switched from steroids to Esbriet or Ofev within six months of diagnosis.

Average adjusted drug costs at the start of the study ranged from € 216 for sarcoidosis to € 1,442 for IPF.

The costs of the IPF drugs increased to € 11,000 at the end of the study. The costs of other LTDs have also increased, but less than those of patients with IPF.

During the year of the study, the average cost of drugs specific to LTDs ranged from € 487 for other LTDs to € 9,142 for IPF.

“Our results showed that patients with IPF had the highest drug costs of any ILD group during the study period, which increased sharply after baseline,” the researchers wrote.

“The reason beyond this observation is the high cost of the two anti-fibrosis drugs approved for IPF, pirfenidone. [Esbriet] and nintedanib [Ofev]”, they added.” Indeed, 12 months after inclusion, when all the patients with IPF had received pirfenidone or nintedanib, the corresponding expenses explained nearly 85% of the total drug costs. “

Esbriet was first approved in the European Union in 2011 and Ofev in 2015.

Among other factors weighing on costs, advanced age was linked to a 10% increase for people with IPF, a 4% increase for people with progressive fibrosis ILD, and a 3% increase. for people with other LTDs.

Notably, smoking increased costs for patients with IPF by 247%.

Better lung function, as shown by a predicted higher forced vital capacity (FVC), associated with lower costs for IPF (9% lower) and sarcoidosis (1% lower).

In all types of LTD, a higher comorbid burden at baseline was associated with a significant increase in drug costs, from 23% in patients with sarcoidosis to an 89% increase in those with sarcoidosis. ‘other DLIs.

This was maintained throughout the year of follow-up, with a higher burden of comorbidities linked to a 52% increase in costs with progressive fibrosing IRS, a 60% increase with sarcoidosis and 24% in the category of other PIDs.

“The burden of comorbidity was a factor in increasing costs in all subtypes, either at baseline or throughout the study period,” the researchers wrote, possibly because “a management Pharmacologically sensitive comorbidities are needed in the treatment of DLI “.

Longer disease duration associated with lower costs with both progressive fibrosing ILD (8% less) and sarcoidosis (6% less). For patients with IPF, however, a longer illness duration increased costs by 11%.

Male gender was linked to higher costs for progressive fibrosis IRS and sarcoidosis.

“The results of our study suggest that the pharmacological management of DLI, in particular that of IPF, imposes a substantial economic burden on the healthcare system in Germany,” the researchers concluded.

“The sharp increase in drug costs suggests that there was a roll-out of ‘Esbriet and Ofev’ until all IPF eligible patients took these drugs in the second half of the study,” as our results show “.

Approaches are needed that could “reduce the burden of co-morbidity and decline in lung function” to “essentially reduce the burden of all IRS on caregivers and the healthcare system”.

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