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Medscape
7 days ago
- Business
- Medscape
EoE Prevalence in US Reaches 1 in 700, Costs $1B Annually
The prevalence of eosinophilic esophagitis (EoE) has increased fivefold in the United States since 2009, now affecting about 1 in 700 people and totaling $1.32 billion in annual healthcare costs, according to recent research. Although EoE has been considered a rare disease, the chronic condition is becoming more common, and healthcare providers should expect to encounter EoE in clinical settings, the study authors wrote. 'Our last assessment of the prevalence and burden of EoE was more than 10 years ago, and we had a strong suspicion we would continue to see increased numbers of patients with EoE and an increasing cost burden related to the condition in the United States,' said senior author Evan S. Dellon, MD, MPH, professor of gastroenterology and hepatology and director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina School of Medicine, Chapel Hill, North Carolina. 'EoE is becoming more common,' Dellon said. 'Healthcare providers should expect to see EoE in their practices, including in the primary care setting, emergency departments, allergy practices, GI [gastrointestinal] practices, ENT [ear, nose, and throat] clinics, and endoscopy suites.' The study was published in Clinical Gastroenterology and Hepatology . Estimating EoE Prevalence Dellon and colleagues analyzed the Merative MarketScan Commercial Claims and Encounters and Medicare Fee-for-Service databases to calculate the annual prevalence of EoE, as well as age- and sex-stratified estimates standardized to the US population. They also calculated healthcare utilization, including medications and endoscopic procedures, to estimate annual EoE-associated costs. Since the EoE billing code was introduced in 2008, the analysis included 2009-2022 MarketScan and 2009-2017 Medicare data. In the MarketScan database, the research team identified 20,435 EoE cases in 2022, with a mean age of 38 years, 16% younger than 18 years, 62% men, and 41% with a comorbid allergic disease code. The most common symptoms and diagnoses were dysphagia (39%), abdominal pain or dyspepsia (24%), and esophageal stricture (19%). Over time, patients also had previous codes for comorbid allergic diseases (64%), dysphagia (62%), or esophageal stricture (32%). In the Medicare database, the research team identified 1913 EoE cases in 2017, with a mean age of 73 years, 47% men, 90% non-Hispanic White, and 36% with a comorbid allergic disease. The most common symptoms and diagnoses were dysphagia (49%), abdominal pain or dyspepsia (35%), and esophageal stricture (30%). Over time, patients also had codes for comorbid allergic diseases (64%), dysphagia (65%), or esophageal stricture (42%). The database numbers translated to EoE prevalences of about 163 cases per 100,000 people in MarketScan in 2022 and 64 cases per 100,000 people in Medicare in 2017. Since 2009, there has been a fivefold increase in prevalence in both databases. In MarketScan, the prevalence was higher among men than among women, at 204 vs 122 cases per 100,000 people. For both sexes, peak prevalence occurred between ages 40 and 44. In Medicare, prevalence was also higher among men than among women, at 79 vs 55 cases per 100,000 people. Peak prevalence occurred between ages 65 and 69. Standardized to the US population, EoE prevalence was 142.5 cases per 100,000 people, extrapolating to 472,380 cases. The overall prevalence was approximately 1 in 700, with rates of 1 in 617 for those younger than 65 years and 1 in 1562 for those aged ≥ 65 years. 'The rapidly increasing prevalence year over year for the entire timeframe of the study was surprising, as were our estimates of the total number of EoE patients in the US, which suggests that EoE is no longer a rare disease and is now seen in about 1 in 700 people,' Dellon said. 'This almost triples our prior estimates of 1 in 2000 from 10 years ago, with all trends suggesting that the prevalence will continue to increase.' Calculating EoE Costs In terms of procedures, endoscopy with dilation or biopsy was used in about 60%-70% of patients with EoE in both MarketScan and Medicare during the years analyzed. In addition, upper endoscopy with biopsy was coded in 80%-90% of patients, guidewire-based dilation in 11%-17% of patients, and balloon-based dilation in 13%-20% of patients. In terms of prescription medications, proton pump inhibitors (41%) and topical steroids (26%) were the most common in MarketScan in 2022, as well as in Medicare in 2017, at 32% and 9%, respectively. When looking at costs by age and sex, the male cohort with the highest costs was aged 10-14 years, estimated at $106.7 million. Among the female cohort, the highest costs were associated with ages 15-19, estimated at $46.5 million. Overall, total EoE-associated healthcare costs were estimated to be $1.04 billion in 2017, and when adjusted for inflation, the costs were estimated at $1.32 billion in 2024. This is likely an underestimate, the authors wrote, given that EoE prevalence has likely increased for ages 65 or older since 2017 and for all ages since 2022. 'Researching the prevalence and costs is essential to improving patient care by highlighting the growing burden of this recently recognized and growing chronic disease, guiding policy and insurer decisions, and advocating for better access to effective treatments and support for patients,' said Joy Chang, MD, assistant professor of medicine in the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan. Chang, who wasn't involved with this study, specializes in eosinophilic GI diseases and researches patient-physician preferences and decision-making in EoE care. 'Clinicians should remain vigilant for symptoms, utilize guideline-based diagnostic approaches, and consider both medical and dietary treatment strategies to optimize patient outcomes and reduce long-term costs,' she said. 'Increased awareness and timely intervention can help mitigate the growing impact of this chronic condition.' The study was supported by a National Institutes of Health grant and used resources from the University of North Carolina Center for Gastrointestinal Biology and Disease. Dellon reported receiving research funding from and having consultant roles with numerous pharmaceutical companies and organizations. Chang reported having no relevant disclosures.
Medscape
15-05-2025
- Health
- Medscape
Multiple Naloxone Administrations Rise in EDs
TOPLINE: The proportion of emergency department (ED) patients requiring multiple naloxone administrations increased from 10.1% in 2016 to 17.4% in 2022 in the MarketScan database and from 3.0% in 2016 to 7.3% in 2022 in the National Emergency Department Sample (NEDS) database, indicating an increasing trend. METHODOLOGY: Researchers conducted a retrospective claims-based cohort study using data from the Merative MarketScan and NEDS databases in the United States between 2016 and 2022. The MarketScan data included 335,846 patients with ED claims for opioid overdose (mean age, 41 years), of whom 27,742 (mean age, 39 years) received naloxone during at least one ED encounter. The NEDS data encompassed 2,087,492 ED visits for opioid overdose (mean age, 46 years), with naloxone administered during 50,791 (mean age, 41 years) of these visits. The primary outcome in MarketScan was the percentage of patients who received multiple naloxone administrations during their first ED visit. The primary outcome in NEDS was the percentage of ED visits with multiple naloxone administrations, among ED visits in which naloxone was administered at least once. TAKEAWAY: Among patients from the MarketScan database who received naloxone, 14.7% received multiple administrations, increasing from 10.1% in 2016 to 17.4% in 2022 ꟷ a 72.8% increase (P < .01 for trend). Among NEDS ED visits during which naloxone was administered, multiple administrations were recorded during 6.3% of these visits, which increased by 146.7%, from 3.0% in 2016 to 7.3% in 2021 (P < .01 for trend). The likelihood of receiving multiple naloxone administrations in the ED increased by 10% (adjusted odds ratio [aOR], 1.10; 95% CI, 1.09-1.12) in MarketScan and 13% (aOR, 1.13; 95% CI, 1.11-1.16) in NEDS each year. The proportion of patients from MarketScan who received naloxone at their first ED visit increased by 60.5%, from 5.8% in 2016 to 9.3% in 2022, and NEDS ED visits with naloxone administration increased by 49.9%, from 1.9% to 2.9%. IN PRACTICE: "Increases in fatal and nonfatal opioid toxicities involving fentanyl have been accompanied by increased use of naloxone in the ED. While a single naloxone administration appears to address the needs of most ED patients, a small but growing percentage of ED patients require multiple naloxone administrations," the authors wrote. SOURCE: The study was led by Rachael Rzasa Lynn, MD, Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado. It was published online on May 8, 2025, in The Journal of Emergency Medicine. LIMITATIONS: Claims data did not include complete information on prehospital naloxone administration or the precise timing of administrations within the ED, making it difficult to distinguish between multiple administrations due to insufficient initial dosing and those due to extended opioid toxicity. Additionally, claims data lacked information on naloxone dose strengths or routes of administration or continuous intravenous infusion details. Additionally, the cross-sectional dataset may not have been fully representative of EDs across the United States. DISCLOSURES: The study was funded by Purdue Pharma. One author reported being a former employee of Genesis Research, which was paid by Purdue. Another author reported being an employee of Purdue. Some authors declared receiving grants or having other ties with various sources. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
