Oxygen Therapy for Fibrosing ILD Tied to Higher Costs, Mortality

Patients with fibrosing interstitial lung disease (ILD) who initiate supplemental oxygen therapy face significantly higher mortality rates and health care costs compared with those who do not receive this treatment.

These findings were presented at the American Thoracic Society 2024 International Conference and are published in the American Journal of Respiratory and Critical Care Medicine.¹

Researchers came to these findings by utilizing data from the Optum Market Clarity database, covering the period from October 2015 to June 2022. The study included 24,680 patients who started oxygen therapy (exposed cohort) and a matched cohort of 24,680 patients who did not (unexposed cohort) and evaluated the clinical and economic impacts of supplemental oxygen therapy among these patients with newly diagnosed fibrosing ILD. The mean age among patients was 68.9 years and about half were male.

Key findings indicated that the exposed cohort had notably higher all-cause health care resource utilization across all categories, compared with the unexposed cohort. Regarding hospitalization, the exposed group had more visits (0.09 vs 0.05 per patient per month [PPPM]) and longer stays (1.24 vs 0.55 days PPPM) than the unexposed group.

This increase in resource utilization translated to an 82% higher total all-cause health care cost for the exposed cohort, with a mean (SD) cost of $8812 ($27,142) PPPM compared with $4847 ($9,983) for the unexposed group. When looking at the medical cost breakdown among the treatment group, this total came from hospitalization ($4655), ambulatory office and outpatient visits ($1519), and other medical costs ($1385), while the remaining $913 came from pharmacy costs.

Supplemental oxygen therapy is a common treatment for fibrosing ILD, but is associated with a higher economic burden and increased mortality | Image credit: Andy Dean – stock.adobe.com

Looking specifically at fibrosing ILD-related health care costs, these PPPM numbers dropped but were still higher for the patients who received supplemental oxygen therapy. The mean (SD) total medical and pharmacy PPPM costs for the exposed group were 3 times the amount for the unexposed group at $4378 (22,468) and $1455 ($6822), respectively. Hospitalization alone made up almost the entire total cost at $3912 for the exposed cohort, and again this cost was much lower for those who did not receive oxygen therapy ($1235). Fibrosing ILD-related health care resource utilization was also lower across the board, still with more (0.06 vs 0.02 PPPM) and longer (0.98 vs 0.37 days PPPM) hospital stays for those receiving oxygen therapy.

The study also highlighted a significant disparity in mortality rates. The censor-adjusted data showed that 54% of patients who received supplemental oxygen therapy died during the follow-up period, compared with 39% who did not receive the treatment (P < .001). This suggests a considerable increase in the risk of death associated with the initiation of supplemental oxygen therapy.

The study's authors concluded that while supplemental oxygen therapy is a common treatment for patients with fibrosing ILD, it is associated with a higher economic burden and increased mortality.

“The study findings indicate that patients diagnosed with fibrosing ILD who initiated O2 therapy bear a higher incremental economic burden and increased all-cause mortality compared to patients who did not yet initiate O2 therapy,” the researchers said. “These findings suggest that future therapies reducing the need for O2 therapy could potentially improve clinical outcomes and alleviate the economic burden among patients with fibrosing ILD.”

Patients with ILD often require supplemental oxygen due to hypoxemia, with estimates suggesting up to 40% may need it, including high-flow support, according to a narrative review published in the Annals of the American Thoracic Society in 2023.² Despite its widespread use, there is limited evidence on the clinical benefits of oxygen therapy in ILD, with most guidelines based on older chronic obstructive pulmonary disease studies. While oxygen can enhance quality of life and exercise capacity for some patients with ILD, it also introduces new challenges and costs.

The review authors also noted that current reimbursement policies as of publication provide minimal support for high-flow oxygen, potentially limiting access for some patients. Given the scant evidence and financial implications, the authors recommended a patient-focused approach for prescribing supplemental oxygen in ILD, noting that further research is needed to better understand its impact.

References

1. Yang J, Steffens A, Olson AL, et al. Evaluating the impact of supplemental oxygen therapy on clinical and economic outcomes in patients with fibrosing interstitial lung disease. Presented at: American Thoracic Society 2024 International Conference; May 19, 2024. https://www.abstractsonline.com/pp8/#!/11007/presentation/5835
2. Clark KP, Degenholtz HB, Lindell KO, Kass DJ. Supplemental oxygen therapy in interstitial lung disease: a narrative review. Ann Am Thorac Soc. 2023;20(11):1541-1549. doi:10.1513/AnnalsATS.202304-391CME