Patient Costs of IPF Care Better with Pirfenidone than Nintedanib

Pirfenidone (Esbriet) is associated with lower all-cause inpatient costs and fewer respiratory health-related hospital days than competitor nintedanib (Ofev) among patients with idiopathic pulmonary fibrosis, according to a new study.

In new data presented at the CHEST 2019 Annual Meeting in New Orleans, investigators found a preferred price tag in treatment with pirfenidone among Medicare-covered patients with IPF.

The findings come a half-decade following when both antifibrotic therapies initially received US Food and Drug Administration (FDA) for the delayed progression of IPF, in 2014.

Led by Sheila Reddy, PhD, investigators conducted a retrospective, observational assessment via the 100% Medicare Research Identifiable File. Eligible patients were aged ≥67 years with an IPF diagnosis during the study period on or before initiation of antifibrotic therapy.

Investigators divided the cohort into 2 treatment groups—pirfenidone or nintedanib initiators—and measured for monthly healthcare utilization measures, excluding hospitalization during the observed treatment period, and weighed during follow-up.

They adjusted baseline confounding factors by using propensity score to stabilize inverse probability of treatment weighing. Baseline covariates included age, gender, region, Charlson comorbidity index (excluding COPD), COPD, stroke, newly diagnosed IPF, pneumonia 3 months prior to initiation, quartile of median income of patient residential area, and distances from patient residential area to ILD specialty center.

Their study identified 3546 patients diagnosed with IPF treated with either initial pirfenidone (n = 2802) or nintedanib (n= 1464). Mean all-cause patient costs, per patient per month, were $1129 for pirfenidone and $1494 for nintedanib (P = .026). Mean all-cause outpatient service costs per patient per month were $581 for pirfenidone and $1042 for nintedanib (P = .553). Mean respiratory-related inpatient costs were $581 for pirfenidone and $833 for nintedanib (P = .041).

Mean all-cause inpatient hospitalizations were reported among 20% of patients on pirfenidone and 22.6% of patients on nintedanib (P = .066), while hospitalized patients on the former therapy averaged fewer days of stay (8.1) than the latter (9.4; P = .101).

Respiratory-related hospitalizations were prevalent in 11.1% of pirfenidone patients and 12.4% of nintedanib patients (P = .257), with days in hospital again being shorter for pirfenidone patients (7.2 days vs 9.3 days; P = .043).

Investigators concluded that pirfenidone is associated with lower all-cause inpatient costs, as well as fewer respiratory-related hospital days—positive indications when treating a critical condition such as IPF, they noted.

“Differences were observed in all-cause inpatient costs, respiratory related inpatient costs, and respiratory-related hospitalization days between antifibrotics,” Reddy and colleagues wrote. “Respiratory-related hospitalizations have been associated with an increased risk of death in IPF.”

The study, “Healthcare Resource Use and Costs in Patients with Idiopathic Pulmonary Fibrosis in the US Medicare Population,” was presented at CHEST 2019.