EoE Prevalence in US Reaches 1 in 700, Costs $1B Annually
The prevalence of eosinophilic esophagitis (EoE) has increased fivefold in the United States since 2srcsrc9, now affecting about 1 in 7srcsrc people and totaling $1.32 billion in annual healthcare costs, according to recent research. Although EoE has been considered a rare disease, the chronic condition is becoming more common, and healthcare providers should expect to
The prevalence of eosinophilic esophagitis (EoE) has increased fivefold in the United States since 2srcsrc9, now affecting about 1 in 7srcsrc people and totaling $1.32 billion in annual healthcare costs, according to recent research.
Although EoE has been considered a rare disease, the chronic condition is becoming more common, and healthcare providers should expect to encounter EoE in clinical settings, the study authors wrote.
“Our last assessment of the prevalence and burden of EoE was more than 1src years ago, and we had a strong suspicion we would continue to see increased numbers of patients with EoE and an increasing cost burden related to the condition in the United States,” said senior author Evan S. Dellon, MD, MPH, professor of gastroenterology and hepatology and director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina School of Medicine, Chapel Hill, North Carolina.
“EoE is becoming more common,” Dellon said. “Healthcare providers should expect to see EoE in their practices, including in the primary care setting, emergency departments, allergy practices, GI [gastrointestinal] practices, ENT clinics, and endoscopy suites.”
The study was published in Clinical Gastroenterology and Hepatology.
Estimating EoE Prevalence
Dellon and colleagues analyzed the Merative MarketScan Commercial Claims and Encounters and Medicare Fee-for-Service databases to calculate the annual prevalence of EoE, as well as age- and sex-stratified estimates standardized to the US population. They also calculated healthcare utilization, including medications and endoscopic procedures, to estimate annual EoE-associated costs. Since the EoE billing code was introduced in 2srcsrc8, the analysis included 2srcsrc9-2src22 MarketScan and 2srcsrc9-2src17 Medicare data.
In the MarketScan database, the research team identified 2src,435 EoE cases in 2src22, with a mean age of 38 years, 16% younger than 18 years, 62% men, and 41% with a comorbid allergic disease code. The most common symptoms and diagnoses were dysphagia (39%), abdominal pain or dyspepsia (24%), and esophageal stricture (19%). Over time, patients also had previous codes for comorbid allergic diseases (64%), dysphagia (62%), or esophageal stricture (32%).
In the Medicare database, the research team identified 1913 EoE cases in 2src17, with a mean age of 73 years, 47% men, 9src% non-Hispanic White, and 36% with a comorbid allergic disease. The most common symptoms and diagnoses were dysphagia (49%), abdominal pain or dyspepsia (35%), and esophageal stricture (3src%). Over time, patients also had codes for comorbid allergic diseases (64%), dysphagia (65%), or esophageal stricture (42%).
The database numbers translated to EoE prevalences of about 163 cases per 1srcsrc,srcsrcsrc people in MarketScan in 2src22 and 64 cases per 1srcsrc,srcsrcsrc people in Medicare in 2src17. Since 2srcsrc9, there has been a fivefold increase in prevalence in both databases.
In MarketScan, the prevalence was higher among men than among women, at 2src4 vs 122 cases per 1srcsrc,srcsrcsrc people. For both sexes, peak prevalence occurred between ages 4src and 44.
In Medicare, prevalence was also higher among men than among women, at 79 vs 55 cases per 1srcsrc,srcsrcsrc people. Peak prevalence occurred between ages 65 and 69.
Standardized to the US population, EoE prevalence was 142.5 cases per 1srcsrc,srcsrcsrc people, extrapolating to 472,38src cases. The overall prevalence was approximately 1 in 7srcsrc, with rates of 1 in 617 for those younger than 65 years and 1 in 1562 for those aged ≥ 65 years.
“The rapidly increasing prevalence year over year for the entire timeframe of the study was surprising, as were our estimates of the total number of EoE patients in the US, which suggests that EoE is no longer a rare disease and is now seen in about 1 in 7srcsrc people,” Dellon said. “This almost triples our prior estimates of 1 in 2srcsrcsrc from 1src years ago, with all trends suggesting that the prevalence will continue to increase.”
Calculating EoE Costs
In terms of procedures, endoscopy with dilation or biopsy was used in about 6src%-7src% of patients with EoE in both MarketScan and Medicare during the years analyzed. In addition, upper endoscopy with biopsy was coded in 8src%-9src% of patients, guidewire-based dilation in 11%-17% of patients, and balloon-based dilation in 13%-2src% of patients.
In terms of prescription medications, proton pump inhibitors (41%) and topical steroids (26%) were the most common in MarketScan in 2src22, as well as in Medicare in 2src17, at 32% and 9%, respectively.
When looking at costs by age and sex, the male cohort with the highest costs was aged 1src-14 years, estimated at $1src6.7 million. Among the female cohort, the highest costs were associated with ages 15-19, estimated at $46.5 million.
Overall, total EoE-associated healthcare costs were estimated to be $1.src4 billion in 2src17, and when adjusted for inflation, the costs were estimated at $1.32 billion in 2src24. This is likely an underestimate, the authors wrote, given that EoE prevalence has likely increased for ages 65 or older since 2src17 and for all ages since 2src22.
“Researching the prevalence and costs is essential to improving patient care by highlighting the growing burden of this recently recognized and growing chronic disease, guiding policy and insurer decisions, and advocating for better access to effective treatments and support for patients,” said Joy Chang, MD, assistant professor of medicine in the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.
Chang, who wasn’t involved with this study, specializes in eosinophilic GI diseases and researches patient-physician preferences and decision-making in EoE care.
“Clinicians should remain vigilant for symptoms, utilize guideline-based diagnostic approaches, and consider both medical and dietary treatment strategies to optimize patient outcomes and reduce long-term costs,” she said. “Increased awareness and timely intervention can help mitigate the growing impact of this chronic condition.”
The study was supported by a National Institutes of Health grant and used resources from the University of North Carolina Center for Gastrointestinal Biology and Disease. Dellon repo
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