Disease Worsening, High Healthcare Costs Seen in CF Patients Insured by Medicaid

A high number of sudden disease worsening episodes — pulmonary exacerbations — and associated increases in healthcare costs were observed in Medicaid patients with cystic fibrosis (CF), according to researchers.

Their study, “The burden of cystic fibrosis in the Medicaid population,” was published in the journal ClinicoEconomics and Outcomes Research.

Cystic fibrosis is a chronic disease affecting about 30,000 people in the U.S. alone. Managing CF is expensive and requires the use of considerable healthcare resources. Pulmonary exacerbations, which lead to in frequent hospitalizations, contribute significantly to healthcare costs.

In the U.S., almost 45 percent of CF patients are covered by Medicaid, the publicly funded free or low-cost insurance program for low-income people and others meeting specific eligibility requirements, such as disabled individuals.

In the study, researchers analyzed the impact of the disease and the frequency of pulmonary exacerbations in CF patients covered by Medicaid. They collected data on patients from the Truven Health MarketScan Medicaid database — a repository of medical and pharmaceutical claims submitted by patients enrolled in Medicaid across the U.S.

The study included data from a total of 1,196 cystic fibrosis patients from 2010 to 2014. All patients were at least 6 years old (mean age 16.1 years) and enrolled in Medicaid for 12 months continuously.

Researchers collected information about patients’ ages, number of hospital visits, length of stay, use of antibiotics, number of pulmonary exacerbation events and their cost, in addition to the overall cost of care.

A pulmonary exacerbation event was considered if any of the following three occurred: hospitalization due to respiratory infection or CF with lung involvement; use of intravenous (IV) antibiotics as an outpatient; or use of oral antibiotics prescribed as treatment for acute CF.

A higher number of Medicaid-enrolled CF patients were in the younger age groups — 35.5 percent of patients were ages 6-11; 29.1 percent were 12-17; 25.6 percent were 18-26; 6.7 percent were 27-34; and 3.2 percent were 35 or older.

Researchers found that 90 percent of the patients across all age groups experienced at least one pulmonary exacerbation event. Of those patients, 50.7 percent reported IV use of antibiotics, and 42.8 percent needed hospitalization.

The re-occurrence of pulmonary exacerbation events was frequent, with 55.7 percent of all patients experiencing at least three events within a year.

The high healthcare costs associated with CF were found to be strongly linked to these pulmonary exacerbation events, and they increased with the age of patients, researchers noted. The mean healthcare expense during a pulmonary exacerbation ranged from $44,589 (for patients ages 6-11) to $116,169 (ages 27-34).

Almost half of CF patients in the study (47.2 percent) required inpatient hospitalization at some point in time. The mean length of hospital stays was 9.7 days.

The percentage of CF patients ages 27-34 who were hospitalized was almost two times that of younger patients ages 6-11: 61.3 percent vs. 32.1 percent.

In the 12-month follow-up period, 26.8 percent of the patients required subsequent hospitalizations with a mean total length of stay of 29.1 days in one year.

According to the researchers, the study “underscores the high rates of recurrent [pulmonary exacerbation] events among Medicaid beneficiaries resulting in increased hospitalizations per year, longer hospital stays, and treatment with IV antibiotics.

“As [pulmonary exacerbation] events lead to a higher risk of permanent lung function loss, treatment strategies to prevent [pulmonary exacerbation] events are especially important for this population,” researchers added.