Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
IBM Watson Health, 75 Binney Street, Cambridge, MA, 02142, USA.
BMC Pulm Med. 2020 Jul 11;20(1):188. doi: 10.1186/s12890-020-01224-5.
Pirfenidone and nintedanib are antifibrotic therapies which slow disease progression in idiopathic pulmonary fibrosis (IPF), an irreversible, progressive lung disease with poor prognosis. We compared adherence, persistence, and healthcare costs between patients initiating one of the two therapies.
We used the IBM Watson Health Commercial and Medicare Supplemental claims databases to select patients with IPF with ≥1 pharmacy claim for pirfenidone or nintedanib between 10/1/2014 and 6/30/2018. Adherence (proportion of days covered ≥0.80) and persistence (time to a gap of ≥60 days without medication or switch to the other antifibrotic medication) based on the days' supply and service date fields on claims were measured over a variable-length follow-up period. Healthcare costs, all-cause and respiratory-related, were measured over the persistent period and a fixed 12-month follow-up period. Inverse probability of treatment weights were applied to models comparing adherence, persistence, and costs between the two cohorts.
Overall, 799 pirfenidone patients and 656 nintedanib patients were identified. Similar proportions of patients were adherent in both cohorts (pirfenidone = 49% vs. nintedanib = 51%) and there was no significant difference in the odds of being adherent after weighting (odds ratio = 1.1, p = 0.513). The proportions of patients who discontinued/switched were also similar (pirfenidone = 41% vs. nintedanib 43%); however, in a weighted model, the hazards of discontinuation/switching was lower for the pirfenidone cohort (hazard ratio = 0.8, p = 0.032). While patients were persistent on therapy, weighted all-cause healthcare costs were comparable (pirfenidone = $11,272 vs. nintedanib = $11,987 per-patient per-month; p = 0.115), but weighted respiratory-related costs were significantly lower for the pirfenidone cohort ($9015 vs. $10,167 per-patient per-month, p < 0.001). Weighted annual total all-cause and respiratory-related healthcare costs were comparable between cohorts over the fixed 12-month follow-up period, but the pirfenidone cohort had significantly lower weighted annual mean antifibrotic drug costs than the nintedanib cohort ($68,850 vs. $77,033, p = 0.007).
Pirfenidone use was associated with longer time to discontinuation/switch, lower antifibrotic drug costs, and lower respiratory-related total costs compared to nintedanib use.
吡非尼酮和尼达尼布是抗纤维化疗法，可减缓特发性肺纤维化（IPF）的疾病进展，IPF 是一种不可逆转的进行性肺部疾病，预后不良。我们比较了起始使用这两种疗法之一的患者的依从性、持续性和医疗保健成本。
我们使用 IBM Watson Health 商业和 Medicare 补充索赔数据库，选择了 2014 年 10 月 1 日至 2018 年 6 月 30 日期间至少有 1 项吡非尼酮或尼达尼布药房索赔的 IPF 患者。基于索赔中的天数供应和服务日期字段，通过可变长度的随访期来衡量依从性（覆盖天数比例≥0.80）和持续性（无药物治疗或改用其他抗纤维化药物的≥60 天间隔时间）。在持续期间和固定的 12 个月随访期间，衡量了全因和呼吸相关的医疗保健成本。在比较两个队列的依从性、持续性和成本的模型中，应用了逆概率治疗权重。
总体而言，共确定了 799 名吡非尼酮患者和 656 名尼达尼布患者。两个队列的患者依从性相似（吡非尼酮=49%与尼达尼布=51%），加权后无显著差异（比值比=1.1，p=0.513）。停止/转换的患者比例也相似（吡非尼酮=41%与尼达尼布=43%）；然而，在加权模型中，吡非尼酮队列的停药/转换风险较低（风险比=0.8，p=0.032）。在患者接受治疗期间，加权全因医疗保健成本相当（吡非尼酮=每位患者每月 11272 美元，尼达尼布=每位患者每月 11987 美元；p=0.115），但吡非尼酮队列的加权呼吸相关成本明显较低（每位患者每月 9015 美元与 10167 美元，p<0.001）。在固定的 12 个月随访期间，加权年度全因和呼吸相关医疗保健总成本在两个队列之间相当，但吡非尼酮队列的加权年度平均抗纤维化药物成本明显低于尼达尼布队列（68850 美元与 77033 美元，p=0.007）。
与尼达尼布相比，使用吡非尼酮与停药/转换时间延长、抗纤维化药物成本降低以及呼吸相关总成本降低相关。
