Healthcare Expenditures and Reimbursement Patterns in Idiopathic Pulmonary Fibrosis: A 10-Year Single-Center Retrospective Cohort Study in Turkey.

BACKGROUND/OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrosing interstitial disease that incurs significant healthcare costs due to diagnostic and treatment needs. This study aimed to estimate healthcare expenses related to IPF diagnosis, treatment, and follow-up, including factors affecting overall expenditure.

METHODS

This retrospective cohort study included 276 IPF patients from a tertiary hospital (2013-2022). Diagnostic and treatment costs were analyzed, including antifibrotic medications (pirfenidone and nintedanib), diagnostic tests (pulmonary function tests and performance evaluation tests), and interventions (fiberoptic bronchoscopy, imaging modalities). Costs in Turkish Lira were converted to United States dollars. Statistical analysis was performed using non-parametric tests to evaluate expenditure correlations with demographic, clinical, and treatment parameters, which included the Mann-Whitney and Spearman Rank Correlation tests when appropriate.

RESULTS

The median healthcare expenditure was USD 429.1 (9.13-21,024.57). Inpatient costs (USD 582.67; USD 250.22 to USD 1751, 25th and 75th percentile, respectively) were higher than outpatient costs (USD 192.36; USD 85.75 to USD 407.47, 25th and 75th percentile, respectively). Antifibrotic regimens did not differ significantly in cost or duration (Z = 0.657; = 0.511) (mean pirfenidone duration: 1.1 ± 1.0 years; mean nintedanib duration: 0.6 ± 0.9 years). Diagnostic tests, particularly pulmonary function tests (PFT) (: 0.001, Rho: 0.337), diffusing capacity of the lungs for carbon monoxide (DLCO) (: 0.001, Rho: 0.516), and high-resolution computed tomography (HRCT) (: 0.001, Rho: 0.327), were the primary drivers of costs. Longer treatment duration was positively correlated with expenditure (Rho: 0.264, : 0.001 and Rho: 0.247, : 0.006 for pirfenidone and nintedanib, respectively) while age showed a weak negative correlation (Rho = -0.184, = 0.002). Gender and type of antifibrotic regimen did not show any significant effect on costs.

DISCUSSION

Diagnostic and follow-up testing were the main contributors to costs, driven by reimbursement requirements and the progressive nature of IPF. Antifibrotic medications, although expensive, provided clinical stability, potentially reducing hospitalization needs but increasing long-term care expenses. Variations in healthcare systems affect expenditures, with Turkey's universal coverage lowering costs compared to Western countries. The study's main limitations include being a single-center, retrospective study and its inability to include comorbidities and disease severity in the statistical analysis.

CONCLUSIONS

IPF management is resource-intensive, with diagnostic tests and follow-up driving costs independent of demographics and treatment modality. Anticipating higher expenditures with prolonged survival and evolving treatment options is crucial for healthcare budget planning. Preparation of healthcare policies accordingly to these observations, which must include an overall increase in cost due to treatment duration and survival, remains a crucial aspect of budget control.