P0320 - Estimating the Indirect and Intangible Costs Associated With Eosinophilic Esophagitis

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Daniel Mullins, PhD

School of Pharmacy, University of Maryland
Baltimore, MD, United States

Tao Fan, PhD, MS¹, Jyoti Aggarwal, MHS², Jeanne Jiang, PhD¹, John Cook, PhD³, Michael Marentette, MBA⁴, Bridgett Goodwin, MS⁵, Nirav K. Desai, MD⁵, Mena Boules, MD¹, Daniel Mullins, PhD⁶
¹Takeda Pharmaceuticals USA, Inc., Lexington, MA; ²OPEN Health, Newton, MA; ³Complete Health Economics and Outcomes Research Solutions, North Wales, PA; ⁴Complete Health Economics and Outcomes Research Solutions, Montréal, PQ, Canada; ⁵Takeda Development Center Americas, Inc., Cambridge, MA; ⁶School of Pharmacy, University of Maryland, Baltimore, MD

Introduction: Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease characterized by esophageal eosinophilia and dysfunction. Indirect costs associated with EoE, such as loss of work, and intangible costs associated with reduced health-related quality of life (HRQoL) are not well documented.

Methods: We used data from a retrospective, cross-sectional, qualitative study of caregivers of children and adolescents (6–17 years old) plus adults (≥18 years old) with EoE and a prospective, cross-sectional, observational study of adults with EoE and healthy adults in the USA. A human capital approach based on self-reported EoE-associated work patterns (reducing working hours or stopping work), weekly salary estimates and general employment rates was used to estimate the potential lost wages per year (yr) because of EoE. For participants who reduced their working hours, an average reduction of 25% was assumed. Estimated HRQoL loss (from a perfect score of 100) captured by the 36-item short-form survey (eight multi-item domains), was converted into EuroQoL 5-Dimension scores (EQ-5D) using an existing algorithm (Table). These were translated into humanistic costs based on the conservative willingness-to-pay US$50,000 per quality-adjusted life year.

Results: Overall, 27 caregivers of children and adolescents, plus adults with EoE (caregivers, n = 9; adults, n = 18) and 88 adults (adults with EoE, n = 44; healthy adults, n = 44) were analyzed for indirect and intangible costs, respectively. Among participants, 22.2% (caregivers, 33.3%; adults, 16.7%) reduced their working hours and 33.3% (caregivers, 55.6%; adults, 22.2%) stopped working for pay owing to EoE (Table). For caregivers of children and adolescents with EoE, estimated yearly indirect costs associated with EoE were US$2473/yr because of reduced working hours and US$16,487/yr because of stopping work. Estimated yearly indirect costs for adults with EoE were US$1237/yr because of reduced working hours and US$6595/yr because of stopping work (Table). Estimated decreases in EQ-5D from perfect health were 11.9 and 4.5 for adults with EoE and healthy adults, respectively; the estimated intangible cost adults with EoE would willingly pay to return to a healthy status was US$3659/yr (Table).

Discussion: Substantial EoE-associated indirect and intangible costs are related to lost wages and HRQoL loss for caregivers of children and adolescents plus adults with EoE, demonstrating the high financial burden, and potential associated burden on HRQoL, of EoE.

Indirect costs
Weekly earnings (Q1 2021),¹ US$	984
Annual earnings, US$*	51,168
General employment rate in the USA,^2,† %	58.0

Impact on caregivers of children and adolescents with EoE
Work status, n (%)^3,‡
Currently working reduced hours owing to EoE	3 (33.3)
Currently not in paid employment, owing to EoE	5 (55.6)
Annual lost earnings, US$
Caregivers who reduced working hours^§	2473
Caregivers who stopped working^¶	16,487

Impact on adults with EoE
Work status, n (%)^3,‡
Currently working reduced hours owing to EoE	3 (16.7)
Currently not in paid employment, owing to EoE	4 (22.2)
Annual lost earnings, US$
Patients who reduced working hours^§	1237
Patients who stopped working^¶	6595

Intangible costs in adults^4,5
SF-36 domain scores (0–100)	Adults with EoE	Healthy controls
Physical functioning	91.7	94.5
Role limitations due to physical problems	85.0	95.4
Bodily pain	80.4	89.9
General perception	64.8	78.9
Energy and vitality	58.1	75.8
Social functioning	84.4	95.4
Role limitations due to emotional problems	87.8	95.4
Mental health	73.4	84.4
Estimated decrease in EQ-5D scores from perfect health	−11.9	−4.5
Humanistic cost based on willingness to pay US$50,000/QALY, US$	5931	2272

Table: Table. Estimated EoE-Associated Indirect And Intangible Costs For Caregivers Of Children And Adolescents Plus Adults With EoE.
*Extrapolated from weekly earnings, using 52 weeks per year; †May 2021; ‡Patients could select more than one response; §Annual earnings × general employment rate × proportion of patients who worked reduced hours owing to EoE × the average reduction in working hours (for which a reduction in working hours of 25% was assumed); ¶Annual earnings × general employment rate × proportion of patients who stopped working owing to EoE.
EoE, eosinophilic esophagitis; EQ-5D, EuroQoL 5-Dimension scores; Q, quarter; QALY, quality-adjusted life year; SF-36, 36-item short-form survey.

1. Bureau of Labor Statistics, US Department of Labor: https://www.bls.gov/news.release/pdf/wkyeng.pdf (Accessed 8 June 2021).
2. https://tradingeconomics.com/united-states/employment-rate#:~:text=Employment%20Rate%20in%20the%20United%20States%20averaged%2059.23%20percent%20from,percent%20in%20April%20of%202020. (Accessed 8 June 2021).
3. Pokrzywinski RM et al. Adv Ther 2020;37:4458–78.
4. Hewett R et al. Dis Esophagus 2017;30:1–7.
5. Ara R et al. Value Health 2008;11:1131–43.

Disclosures:

Tao Fan: Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds). Takeda Pharmaceuticals USA, Inc. – Employee.

Jyoti Aggarwal: OPEN Health – Employee.

Jeanne Jiang: Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds). Takeda Pharmaceuticals USA, Inc. – Employee.

John Cook: Complete Health Economics and Outcomes Research Solutions – Employee.

Michael Marentette: Complete Health Economics and Outcomes Research Solutions – Employee.

Bridgett Goodwin: Takeda Development Center Americas, Inc. – Employee. Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds).

Nirav Desai: Takeda Development Center Americas, Inc. – Employee. Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds).

Mena Boules: Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds). Takeda Pharmaceuticals USA, Inc. – Employee.

Daniel Mullins: Agency for Healthcare Research and Quality – Other Financial or Material Support, Funding. AstraZeneca – Other Financial or Material Support, Personal fees. Bayer – Consultant. Bayer Pharmaceuticals – Other Financial or Material Support, Personal fees. Boehringer-Ingelheim – Consultant. Incyte – Other Financial or Material Support, Personal fees. Janssen/Johnson & Johnson – Consultant. Merck – Consultant, Other Financial or Material Support, Personal fees. Pfizer – Consultant. Regeneron – Consultant. Sanofi – Other Financial or Material Support, Personal fees. Sanofi-Aventis – Consultant. Takeda – Other Financial or Material Support, Personal fees that are unrelated to this study.

Tao Fan, PhD, MS¹, Jyoti Aggarwal, MHS², Jeanne Jiang, PhD¹, John Cook, PhD³, Michael Marentette, MBA⁴, Bridgett Goodwin, MS⁵, Nirav K. Desai, MD⁵, Mena Boules, MD¹, Daniel Mullins, PhD⁶. P0320 - Estimating the Indirect and Intangible Costs Associated With Eosinophilic Esophagitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.