Eosinophil-associated diseases (EADs) are a group of heterogeneous conditions that includes eosinophilic oesophagitis (EoE), a chronic inflammatory disorder of the oesophagus. REVEAL is a retrospective, observational claims study which characterized EAD overlap; this sub-study aimed to understand EAD overlap by quantifying healthcare resource utilization (HCRU) and associated costs. We present all-cause, EAD-related, and EoE-related HCRU by EoE severity with and without overlapping conditions.

This study used US Optum Clinformatics claims data from 2015-2019. Eligible patients had ≥1 diagnosis for an EAD and continuous health plan eligibility 12 months before, and ≥2 years after, the first EAD claim. Descriptive analyses were conducted to assess baseline characteristics, outcomes, and per patient annualized healthcare costs. Costs were standardized to 2020 US dollars using the medical care services Consumer Price Index.

In total, 13,062 eligible patients with EoE were included; 59.4% were male, and the mean age was 48.9 years. Severe EoE, defined by dilation or oral corticosteroid use, was present in 686 patients (5.3%). Overall, 36.6% of patients had overlapping EADs, with 25.6%, 8.2%, and 2.8% having 1, 2, and ≥3 overlapping EADs, respectively. The most common overlapping EAD was persistent asthma (16.6%), and overlap with persistent asthma was greater in severe EoE vs non-severe EoE (24.2% vs 16.0%). Total all-cause costs were $30,977, EAD-related costs were $4,697, and EoE-related costs were $1,517. Compared to non-severe EoE, severe EoE had almost doubled all-cause costs ($59,670 vs $29,387) and tripled EAD-related ($13,476 vs $4,211) and EoE-related costs ($4,780 vs $1,336; Figure). Outpatient visits (mean: 12 visits/year) accounted for 52% of all-cause costs while inpatient admissions (mean length of stay [LOS]: 1 day/year) accounted for 26%; in those with severe EoE, outpatient visits (mean: 16 visits/year) accounted for 47% of all-cause costs while inpatient admissions (mean LOS: 2 days/year) accounted for 33%. All-cause costs were almost doubled in patients with ≥2 EADs vs those with no overlap ($47,505 vs. $20,266) and quadrupled in those with ≥3 EADs ($87,013 vs $20,266); trends were similar in severe and non-severe EoE.

More severe EoE and more overlapping EADs were associated with higher healthcare costs: frequent outpatient and inpatient visits were the key drivers of health expenditure in EoE.