Healthcare Resources Utilization and Costs of Patients with Non-IPF Progressive Fibrosing Interstitial Lung Disease Based on Insurance Claims in the USA

Introduction

Idiopathic pulmonary fibrosis (IPF) is the classic progressive fibrosing interstitial lung disease (ILD), but some patients with ILDs other than IPF also develop a progressive fibrosing phenotype (PF-ILD). Information on use and cost of healthcare resources in patients with PF-ILD is limited.

Methods

We used USA-based medical insurance claims (2014–2016) to assess use and cost of healthcare resources in PF-ILD. Patients with at least two ILD claims and at least one pulmonologist visit were considered to have ILD. Pulmonologist visit frequency was used as a proxy to identify PF-ILD (at least four visits in 2016, or at least three more visits in 2016 vs. 2014).

Results

Of 2517 patients with non-IPF ILD, 15% (n = 373) had PF-ILD. Mean annual medical costs associated with ILD claims were $35,364 in patients with non-IPF PF-ILD versus $20,211 in the non-IPF ILD population. In 2016, patients with non-IPF PF-ILD made more hospital ILD claims than patients with non-IPF ILD (10.5 vs. 4.7).

Conclusions

These findings suggest higher disease severity and overall healthcare use for patients with a non-IPF ILD manifesting a progressive fibrosing phenotype (non-IPF PF-ILD).

Electronic supplementary material

The online version of this article (10.1007/s12325-020-01380-4) contains supplementary material, which is available to authorized users.

Interstitial lung disease (ILD) is a group of similar lung conditions with lung fibrosis, scarring, or inflammation of the lung tissue. Some patients with ILD also have worsening lung fibrosis, referred to as “progressive fibrosis” (PF-ILD). The most common type of PF-ILD is idiopathic pulmonary fibrosis (IPF), which has no known cause. Although much is known about IPF, there is limited information available on how often patients with ILDs other than IPF (non-IPF ILD) use healthcare, or the costs associated with the disease. This study used US medical insurance claims to gain further insights. The study examined data from over 2500 patients with non-IPF ILD, of which 15% had PF-ILD. Patients defined as having PF-ILD had higher yearly medical costs and used healthcare services more often than other patients with ILD. This study highlights the economic burden of non-IPF ILD with progressive fibrosis (non-IPF PF-ILD).

Progressive fibrosing interstitial lung diseases: current practice in diagnosis and management

Objective: Some patients with interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) develop a progressive fibrosing phenotype. We investigated the diagnosis and management of non-IPF ILDs using data from a survey of physicians and from US insurance claims. Methods: Pulmonologists, rheumatologists and internists in France, Germany, Italy, Japan, Spain, UK and US who had managed ≥10 patients with non-IPF ILDs in the past year, including those with progressive fibrosing ILDs, completed an online survey. Data on US insurance and prescription claims were obtained from a repository that aggregates data on claims routed from providers or pharmacies to payers. Results: In May-June 2017, 243 pulmonologists, 203 rheumatologists and 40 internists completed an online survey. Respondents estimated that 18-32% of patients diagnosed with non-IPF ILDs develop progressive fibrosis and that time from symptom onset to death in these patients was 61-80 months. Drug treatment was given to 50-75% of patients with non-IPF progressive fibrosing ILDs. Reasons for patients not being treated included that physicians considered patients to have mild or slowly progressing disease, or did not believe that available treatments are effective or well tolerated. Corticosteroids were the preferred first-line treatment for all types of non-IPF ILD. There was considerable heterogeneity in preferences for second- and third-line treatments. US insurance claims data from 3823 patients indicated that, in 2016, 50-75% of patients with ILDs received drug treatment (mostly corticosteroids) for their ILD. Conclusions: Physicians estimate that 18-32% of patients diagnosed with non-IPF ILDs develop a progressive fibrosing phenotype and that these patients experience significant delays in the diagnosis of ILD and the detection of progressive fibrosis. Between 25% and 50% of patients with progressive fibrosing ILDs do not receive drug therapy. There is an unmet need for effective and well tolerated treatments for progressive fibrosing ILDs.

Removal of Basic Red 46 dye from aqueous solution by adsorption onto Moroccan clay

In this study, Moroccan crude clay of Safi, which was characterized by X-ray diffraction, is used as adsorbent for the investigation of the adsorption kinetics, isotherms and thermodynamic parameters of the Basic Red 46 (BR46) in aqueous solutions at various dye concentrations, adsorbent masses and pH values. The results showed that the adsorption capacity of the dye increased by initial dye concentration and pH values. Two kinetic models (the pseudo-first-order and the pseudo-second-order) were used to calculate the adsorption rate constants. The adsorption kinetics of the basic dye followed pseudo-second-order model. The experimental data isotherms were analyzed using the Langmuir, Freundlich and Dubinin-Radushkevish equations. The monolayer adsorption capacity for BR46 dye is 54 mg/g of crude clay. Nearly 20 min of contact time was found to be sufficient for the dye adsorption to reach equilibrium. Thermodynamical parameters were also evaluated for the dye-adsorbent system and revealed that the adsorption process is exothermic in nature.

Discoloration of a red cationic dye by supported TiO(2) photocatalysis

The degradation under UV, visible and sunlight irradiation of C.I. Basic Red 46 (BR 46) dye used for acrylic fibers dyeing has been studied in a lab-scale continuous system with two different immobilized TiO(2) systems. Catalyst I was based on TiO(2) particles deposited on cellulose fibers; Catalyst II combined TiO(2) particles deposited on a layer of cellulose fibers (as in Catalyst I) with a layer of carbon fibers and finally a layer of cellulose fibers. The treatment of aqueous dye solutions and industrial wastewater contaminated with the same dye has been evaluated in terms of color removal and chemical oxygen demand (COD) decrease. With UV light, aqueous solutions containing dye were decolorized slightly more rapidly with Catalyst II than with Catalyst I. Sunlight was also very effective and experiments involving sunlight irradiation showed Catalyst II to be the more efficient, giving more than 90% discoloration after 20 min of treatment. Comparing the discoloration yield by adsorption or under visible light for both catalysts, it was observed that the difference between them is below 5%. The adsorption kinetics was found to follow a second-order rate law for Catalyst I and a first-order rate law for Catalyst II. The kinetics of photocatalytic degradation under UV or sunlight were found to follow a first-order rate law for both catalytic systems. Under sunlight the COD removal yield for textile wastewater reaches 33% with Catalyst I against 93% with Catalyst II.