Frequency and costs of pulmonary exacerbations in patients with cystic fibrosis in the United States

Abstract

Background: Information is limited regarding the cost of pulmonary exacerbations (PEx) among patients with cystic fibrosis in the United States.

Methods: To examine PEx costs, medical chart data were linked to insurance claims for patients aged ≥6 years who had commercial coverage from a large US health insurer affiliated with Optum during 2008–2013. A PEx was categorized as an episode requiring newly started (1) oral antibiotics (PEx-O) or (2) intravenous (IV) antibiotics and/or inpatient stay (PEx-IV).

Results: Among 241 patients, 88.0% had ≥1 PEx (2.9/year) of any type, and 48.1% had ≥1 PEx-IV. Prior PEx-IV was the strongest risk factor for subsequent PEx-IV. The mean cost per episode was $12,784 for PEx of any type and $36,319 for PEx-IV. Patients with worse lung function were more likely to experience a PEx and incurred higher annual PEx-related costs.

Limitations: This was an observational study using a convenience sample of patients with commercial coverage from a large US health insurer whose medical charts were available for abstraction. Results of the study may not be generalizable to individuals with Medicaid coverage and other types of insurance, or to the uninsured.

Conclusions: Most patients experience ≥1 PEx annually, and nearly half require IV antibiotics and/or inpatient stay at considerable cost.

Keywords:

• Cystic fibrosis
• Healthcare administrative claims
• Healthcare costs
• Pulmonary exacerbations
• Risk factors

Transparency

Declaration of funding

This study was funded by Vertex Pharmaceuticals Incorporated. Vertex Pharmaceuticals Incorporated contracted with Optum to perform this study.

Author contributions: All authors were involved in the conception and design of the study, analysis and interpretation of the data, and the drafting, revision and final approval of the manuscript. All authors agree to be accountable for all aspects of the study.

Declaration of financial/other relationships

P.S.H. and J.L.R. have disclosed that they are employees of Vertex Pharmaceuticals Incorporated and may own stock or stock options in that company. S.T. and A.W. have disclosed that they are employees of Optum, which was funded by Vertex Pharmaceuticals Incorporated. J.S.W. has disclosed that he was previously employed by Vertex Pharmaceuticals Incorporated and is currently an employee of the University of Colorado Medical School and a paid consultant of Vertex Pharmaceuticals Incorporated. M.S.S. has disclosed that he is an employee of Virginia Commonwealth University and a paid consultant of Vertex Pharmaceuticals Incorporated.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing and editorial support were provided by Optum, Jeremy Kennard, PhD and Dena McWain of Ashfield Healthcare Communications, and funded by Vertex Pharmaceuticals Incorporated. Editorial coordination and support was provided by Dhrupad Patel, PharmD who is an employee of Vertex Pharmaceuticals Incorporated and may own stock or stock options in that company.