Disease Overlap, Healthcare Resource Utilization, and Costs in Patients with Eosinophilic Granulomatosis with Polyangiitis: A REVEAL Sub-study

Xiao Xu; Christopher Edmonds; YongJin Kim; Michael Stokes; Heide A Stirnadel-Farrant; Justin Kwiatek; Rohit Katial

doi:10.1007/s40744-024-00714-w

Disease Overlap, Healthcare Resource Utilization, and Costs in Patients with Eosinophilic Granulomatosis with Polyangiitis: A REVEAL Sub-study

Rheumatol Ther. 2024 Dec;11(6):1611-1628. doi: 10.1007/s40744-024-00714-w. Epub 2024 Oct 24.

Authors

Xiao Xu^{1

2}, Christopher Edmonds³, YongJin Kim⁴, Michael Stokes⁴, Heide A Stirnadel-Farrant⁵, Justin Kwiatek⁶, Rohit Katial⁷

Affiliations

¹ BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA. [email protected].
² Global Price and Market Access, AstraZeneca, Gaithersburg, MD, USA. [email protected].
³ Global Price and Market Access, AstraZeneca, Gaithersburg, MD, USA.
⁴ Data Analytics, Evidera/PPD, Saint-Laurent, QC, Canada.
⁵ BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
⁶ BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA.
⁷ BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA.

Abstract

Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophil-associated disease (EAD) characterized by inflammation in small- to medium-sized blood vessels. In the REal-world inVestigation of Eosinophilic-Associated disease overLap (REVEAL) study, overlap among 11 EADs was assessed. In the present sub-study, we evaluated EGPA overlap with other EADs, all-cause EAD- and EGPA-related healthcare resource utilization (HCRU) and costs, and their relationship with blood eosinophil count and treatments received.

Methods: REVEAL, a retrospective study, used Optum's de-identified Clinformatics^® Data Mart Database. In this sub-study, eligibility criteria included an age of ≥ 12 years, ≥ 1 EAD, continuous health-plan eligibility, and compliance with the EGPA/GPA case definition per International Classification of Diseases Ninth/Tenth Revision diagnostic codes between 1 January 2015 and 30 June 2018. Patients were grouped based on whether they had received immunomodulators/cyclophosphamide/mepolizumab (ICM) or not (non-ICM).

Results: Of 701 patients with EGPA, 29.5% were in the ICM group. Overall, 72.2% had ≥ 1 overlapping EAD. The number of overlaps was similar for the ICM and non-ICM groups. In patients with blood eosinophil counts ≥ 300 cells/µL, 22.8% had ≥ 1 overlapping EAD. The mean annual all-cause cost was $98,644, 54.1% of which was from outpatients and 33.6% from inpatients. The mean annual EAD- and EGPA-related costs were $23,820 and $9,306, respectively. Patients in the non-ICM group versus the ICM group had higher all-cause ($101,560 vs $91,684) but lower EAD-related ($22,733 vs $26,412) and EGPA-related ($6,171 vs $16,786) costs. All-cause HCRU and costs increased with increasing overlap.

Conclusions: EGPA was associated with substantial HCRU and costs, driven by outpatient and inpatient settings. More overlapping EADs were associated with higher HCRU and costs, highlighting the need for treatment to reduce healthcare expenditure in these patients. Infographic available for this article.

Keywords: Disease overlap; Eosinophil-associated diseases (EADs); Eosinophilic granulomatosis with polyangiitis (EGPA); Eosinophilic inflammation; Healthcare costs; Healthcare resource utilization (HCRU).