Epidemiology, healthcare utilization, and related costs among patients with IPF: results from a German claims database analysis

Abstract

Background Idiopathic pulmonary fibrosis (IPF) is a progressive form of fibrosing interstitial pneumonia with poor survival. This study provides insight into the epidemiology, cost, and disease course of IPF in Germany. Methods A cohort of incident patients with IPF (n = 1737) was identified from German claims data (2014–2019). Incidence and prevalence rates were calculated and adjusted for age differences compared with the overall German population. All-cause and IPF-related healthcare resource utilization as well as associated costs were evaluated per observed person-year (PY) following the initial IPF diagnosis. Finally, Kaplan–Meier analyses were performed to assess time from initial diagnosis to disease deterioration (using three proxy measures: non-elective hospitalization, IPF-related hospitalization, long-term oxygen therapy [LTOT]); antifibrotic therapy initiation; and all-cause death. Results The cumulative incidence of IPF was estimated at 10.7 per 100,000 individuals in 2016, 10.9 in 2017, 10.5 in 2018, and 9.6 in 2019. The point prevalence rates per 100,000 individuals for the respective years were 21.7, 23.5, 24.1, and 24.1. On average, ≥ 14 physician visits and nearly two hospitalizations per PY were observed after the initial IPF diagnosis. Of total all-cause direct costs (€15,721/PY), 55.7% (€8754/PY) were due to hospitalizations and 29.1% (€4572/PY) were due to medication. Medication accounted for 49.4% (€1470/PY) and hospitalizations for 34.8% (€1034/PY) of total IPF-related direct costs (€2973/PY). Within 2 years of the initial IPF diagnosis (23.6 months), 25% of patients died. Within 5 years of diagnosis, 53.1% of patients had initiated LTOT; only 11.6% were treated with antifibrotic agents. The median time from the initial diagnosis to the first non-elective hospitalization was 5.5 months. Conclusion The incidence and prevalence of IPF in Germany are at the higher end of the range reported in the literature. The main driver for all-cause cost was hospitalization. IPF-related costs were mainly driven by medication, with antifibrotic agents accounting for around one-third of the total medication costs even if not frequently prescribed. Most patients with IPF do not receive pharmacological treatment, highlighting the existing unmet medical need for effective and well-tolerated therapies.

Einsatz antifibrotischer Medikamente bei interstitiellen Lungenerkrankungen

“…Aktuelle Studien – auch aus Deutschland – zeigen, dass nach Diagnosestellung längst nicht alle IPF-Patienten eine antifibrotische Therapie erhalten und dass die Therapieadhärenz nach 1 Jahr bei ca. 60 % liegt 15 16 . Gründe hierfür können im Einzelfall sehr hohes Alter, Multimorbidität, Pflegebedürftigkeit und prognoselimitierende Begleiterkrankungen sein; diese sollten jedoch jeweils kritisch gegenüber dem möglichen Nutzen einer Therapie abgewogen werden.…”

The Role of Nrf2 in Pulmonary Fibrosis: Molecular Mechanisms and Treatment Approaches

“…An array of triggers, including environmental pollutants, herbicides, drug side effects, particles, genetic abnormalities, autoimmune disorders, chronic infection, and cigarette smoking may cause IPF [ 9 , 10 , 11 , 12 ]. Nearly 200,000 people in the United States and over 5 million people worldwide are affected by IPF, and approximately 82–83% of deaths, incident cases, and prevalent cases occur in patients over 70 years old, imposing a great economic burden on the country as well as individuals [ 13 , 14 , 15 ]. A recent study from Germany showed that most patients with IPF did not receive medication [ 13 ], but previous research has demonstrated that patients who develop IPF without being treated have a median survival of only 3–5 years after diagnosis [ 3 ].…”

“…Nearly 200,000 people in the United States and over 5 million people worldwide are affected by IPF, and approximately 82–83% of deaths, incident cases, and prevalent cases occur in patients over 70 years old, imposing a great economic burden on the country as well as individuals [ 13 , 14 , 15 ]. A recent study from Germany showed that most patients with IPF did not receive medication [ 13 ], but previous research has demonstrated that patients who develop IPF without being treated have a median survival of only 3–5 years after diagnosis [ 3 ]. Consequently, there remains a major medical need for effective, safe, and well-tolerated treatments for IPF.…”