BACKGROUND: Nintedanib was approved for treatment of idiopathic pulmonary fibrosis (IPF) in 2014; however, limited data exist regarding real-world nintedanib treatment patterns.
OBJECTIVE: This study assessed persistence of nintedanib among IPF patients and estimated health care cost after nintedanib was discontinued or dose-adjusted.
METHODS: This retrospective administrative claims analysis included adults ≥40 years with at least one IPF diagnosis and initiating nintedanib from 10/15/2014-5/1/2017. The first observed nintedanib prescription defined the index date and patients were required to have ≥6 months pre- and ≥2 months post-index date continuous enrollment. Demographic and clinical characteristics, persistence, and treatment patterns were reported for all patients who met the inclusion criteria. Two mutually exclusive study cohorts, discontinuation with no restart cohort (DWNR) and dosage reduction cohort (DR), were defined based on treatment changes among patients with no pirfenidone use during follow-up. Average monthly all-cause medical costs, (e. g. , inpatient, outpatient, and emergency room costs) were reported for the post-discontinuation or dose reduction periods.
RESULTS: In total, 845 patients with IPF who initiated OFEV were included (mean [SD] age: 74. 4 [8. 2] years, 61% male). Patients were followed for mean (SD) 400. 8 (240. 7) days, during which time, 41% discontinued therapy without restart (mean [SD] 129. 1 [141. 1] days from index to discontinuation) and 17% discontinued therapy with a subsequent restart (mean [SD] 121. 7 [72. 1] days from discontinuation to restart). Among patients with discontinuation, 8% switched to pirfenidone (mean [SD] 129. 4 [129. 6] days from discontinuation to pirfenidone initiation). Among all patients, 15% reduced and 17% increased their initial dose. Among the DWNR (n=286) and DR (n=51) cohorts, mean (SD) monthly medical costs were $2804 ($7477) post-discontinuation and $1973 ($3448) post-dosage reduction, respectively. Inpatient visits were responsible for 57. 4% and 43. 1% of the medical costs for the DWNR and DR cohorts, respectively.
CONCLUSIONS: Nintedanib dose reduction may be associated with lower medical cost compared to permanent discontinuation. Healthcare stakeholders should consider adopting strategies to increase medication persistence, which may in turn improve patient outcomes while potentially reducing healthcare costs.
