Nationwide trends in the medical care costs of privately insured patients with cystic fibrosis (CF), 2001-2007.

BACKGROUND

Longer survival of patients with cystic fibrosis (CF) has been linked to initiation of national newborn screening, new therapies that prevent and treat pulmonary exacerbations, and closer monitoring of health outcomes. However, few studies have examined the economic impact of these medical advances on costs, and none have examined these costs longitudinally.

METHODS

We used a nationwide database of the healthcare claims of privately insured individuals with CF between 2001 and 2007. Study subjects had at least two claims with diagnoses of CF (ICD-277.xx). We extracted inpatient admissions, outpatient visits, prescribed therapies, and screening procedures and then calculated all-cause medical utilization and annual medical costs, adjusted for inflation. We adjusted for comorbidity burden and tested longitudinal time trends using regression models.

RESULTS

We identified 3,273 individuals with CF. Overall, the costs of prescription drugs, outpatient visits, and durable medical equipment increased by 59% during the 7-year period ($18,715 in 2001 vs. $29,718 in 2007, P < 0.001). The proportion of individuals hospitalized increased from 24.0% to 38.9%, P < 0.001. Annual testing of pulmonary function increased 53% (49.9% in 2001 to 76.3% in 2007, P < 0.001) and respiratory cultures more than doubled (27.9-67.5%, P < 0.001). Use of CF-related therapies also significantly increased (dornase alfa, 32.1-52.4%, P < 0.001; oral antibiotics, 54.1-71.8%, P = 0.007). Analyses by age showed the largest increases in total medical care costs occurred for the oldest CF patients (aged >30; $20,536 in 2001 to $56,116 in 2007, P < 0.001) and the youngest (aged <11; $3,060 in 2001 to $31,723 in 2007, P < 0.001).

CONCLUSIONS

Although improvements in diagnosis and treatment have yielded substantial benefits, they have come at considerable cost, both in terms of treatment burden and healthcare dollars.