P91 Real-world healthcare resource utilization in patients with idiopathic pulmonary fibrosis initiating antifibrotic therapy in the medicare fee-for-service population

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Objectives To characterize treatment patterns and healthcare resource utilization in patients with idiopathic pulmonary fibrosis initiating antifibrotic therapy. Methods A retrospective cohort study was conducted using the 100% Medicare Fee-For-Service data to identify patients who initiated antifibrotic therapy (nintendanib or pirfenidone) between 01/01/17 and 12/31/22. Eligible patients were aged ≥18, had ≥1 inpatient or ≥2 outpatient IPF diagnosis claims pre-index, continuously enrolled for 6-months prior and had no prior antifibrotic therapy or lung transplant. Discontinuation, using a 45-day gap definition, per-person per-month (PPPM) healthcare resource utilization and mortality were examined. Patients were censored at the earliest occurrence of switching to the other antifibrotic, lung transplant, death, end of enrollment, or end of data. Unadjusted time-to-event was estimated using Kaplan-Meier Cox-proportional hazards model identified characteristics associated with discontinuation. Results 5,397 patients met selection criteria, 3,555 initiating nintendanib and/or 2,496 initiating pirfenidone. For all patients, mean (SD) age at initiation was 75.6(7.3), with 38% female, 87% white race and mean (SD) Deyo Charlson comorbidity index score of 2.6(2.4). 25% of patients discontinued antifibrotic therapy at 3 months and 50% at 11 months. Mean (SD) PPPM inpatient hospitalizations increased from 0.07(0.13) in the pre-index to 0.10(0.26) in the post-index. 25% and 50% of patients died at 18 and 41 months after initiation, respectively. Patients that were aged ≥75 were more likely to discontinue (HR 1.23; 95%CI: 1.14–1.33) therapy relative to those aged <75. Men (HR:0.76; 95%CI:0.71–0.81) and patients that experienced a hospitalization prior to initiation (HR:0.85; 95%CI: 0.78–0.94) were less likely to discontinue therapy, after adjustment. Conclusions Patients with IPF have high treatment discontinuation to antifibrotic therapy, hospitalizations and mortality. A large unmet need remains in patients with idiopathic pulmonary fibrosis.

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