Influence of Idiopathic Pulmonary Fibrosis Progression on Healthcare Resource Use

Abstract

Background Disease progression and acute exacerbations in patients with idiopathic pulmonary fibrosis (IPF) are associated with high morbidity and mortality. They usually require a visit to a specialist or a general practitioner (GP) in less severe cases or hospitalisation in more severe cases. Objective The objective of this study was to identify factors that influence resource use in IPF. Methods Clinical and healthcare resource use data were collected in two large, international, multi-centre, randomised controlled trials (RCTs) that studied nintedanib for the treatment of IPF (INPULSIS-1 and -2). The pooled data of nintedanib and placebo included 1014 patients followed for 12 months. The trial data were analysed in 3-month intervals. We studied two dependent variables: the occurrence of allcause hospitalisation and visits to a physician (GP or specialist). The independent variables included the change in forced vital capacity percent predicted (FVC%pred), investigator-reported acute exacerbation events, age, time since diagnosis, smoking status, and sex. Results Hospitalisation during a 3-month interval was significantly associated with a drop of at least 5 or 10 points in FVC%pred (odds ratios [ORs] 1.58 [p = 0.009] and 2.62[p \ 0.001]) and associated with the occurrence of at least one acute exacerbation (OR 14.44; p \ 0.001) during the same interval. The above factors remained significant when repeating the analysis for hospitalisation based on change in FVC%pred or events occurring during the previous 3 months interval. Smoker status and a unit change in FVC%pred during the previous interval were added to the significant factors. Physician visits during a 3-month interval were significantly associated with a lower FVC%pred at the start of the interval (per 10-point decrement, OR 1.05; p = 0.040) and with the change in FVC%pred during the same interval (per 10-point loss, OR 1.13; p = 0.042). Visits were also associated with a 5-point drop in FVC%pred (OR 1.23; p = 0.020), age (per 5-year increments OR 1.07; p = 0.028), and female sex (OR 1.32; p = 0.017). Nevertheless, the predictive power of the models was considered poor for both outcomes (hospitalisation and physician visits). Conclusions Disease progression and acute exacerbation events are significantly associated with hospitalisation of patients with IPF. Outpatient visits to physicians are associated with disease progression, baseline FVC%pred, age and sex.

A retrospective study of in-hospital mortality in patients with idiopathic pulmonary fibrosis between 2015 and 2018

“…This is consistent with our earlier study based on the PHD, [ 9 ] but lower than observed in other observational studies, in which the mean or median length of stay ranged from 8.3 to 10.6 days. [ 5 , 7 , 10 , 13 ] In our study, length of stay was longer in patients with pneumothorax or pneumonia, and in patients admitted to the ICU or receiving mechanical ventilation. Approximately 30% of patients hospitalized in our study were readmitted to hospital within 90 days, with admission to hospital within the previous year the strongest predictor of readmission.…”

In-Hospital Mortality in Patients with Idiopathic Pulmonary Fibrosis: A US Cohort Study

“…The median length of hospital stay was 5 days. This is shorter than the lengths of stay reported in previous real-world studies and clinical trials, which have ranged from 7 to 10.2 days [3, 7, 8, 20, 27], likely reflecting differing patient populations and healthcare systems. Length of stay was 32% longer in patients receiving intensive care.…”