Eosinophilic Esophagitis Drives Up Health Care Costs Following Diagnosis

Health care expenses associated with the management of eosinophilic esophagitis (EoE) increase in the year following diagnosis and remain above general-population costs for up to 5 years after diagnosis, according to a study from Sweden, presented at the Digestive Disease Week 2024 meeting.

Chronic diseases are associated with increased health care costs and constitute an economic burden for patients and health care systems. While observational studies have shown that EoE can cause significant financial stress, researchers at Karolinska Institute in Stockholm, Sweden wanted to find out how societal costs associated with this condition may vary over time. Soran Rabin Bozorg, MD and colleagues in the Department of Medical Epidemiology and Biostatistics designed a study to investigate the societal costs that patients incur before and after receiving a diagnosis of EoE, including health care expenses and lost income, and how those compare with the costs incurred by individuals who do not have EoE. The study included 1,415 Swedish patients diagnosed with EoE between 2010 and 2016, whose diagnoses had been confirmed by biopsy specimens. Each patient was compared to up to five general-population comparators matched for sex, birth year, and county of residence. The societal costs derived from national registries in Sweden included health care utilization, cost of prescription medications, and loss of income due to sick leave and disability leave.

Before receiving a diagnosis of EoE, patients who participated in the study had comparable costs to those of people without EoE. However, health care-related costs increased significantly for people with EoE in the year following the diagnosis, with the mean cost per patient with EoE exceeding $6,000, whereas the mean health care costs incurred by individuals without EoE were around $3,600. All costs were adjusted for inflation and converted from the Swedish currency, SEK, to U.S. dollars based on the annual average exchange rate in 2022. The study also showed that the mean health care costs incurred by patients with EoE remained elevated up to 5 years after diagnosis. The post-diagnostic excess cost was most prominent in pediatric patients, with adult patients experiencing a significant increase in health care costs only during the year of diagnosis.

The investigators noted that the increase in costs was driven mostly by outpatient visits and hospitalizations, and to a lesser extent by the cost of medications. Although the study showed a trend toward missed work time after the diagnosis, there was no significant cost difference related to work loss throughout the follow-up period. However, studies with longer follow-up periods are needed to assess costs related to work loss beyond 5 years, the authors said.

While these results provide a glimpse into the economic impact that EoE can have on individuals, families, and nations, they may not reflect realities in other geographic and economic spheres. Sweden relies on a tax-funded health care system that provides citizens with universal access to health care services, prescription medications, and social insurance, whereas residents of other countries may experience a higher burden in the form of out-of-pocket costs, private insurance premiums, and loss of income. Additional studies with diverse cohorts may help clarify the economic impact of this chronic condition.