Patients with overlapping eosinophilic conditions have a higher burden of disease and account for significantly increased health care costs compared with patients with only one eosinophilic disease, investigators stated in a poster presentation at Disease Disease Week 2022 in San Diego, California.

The REVEAL retrospective observational claims study was designed to characterize this overlap between eosinophilic gastric diseases (EGIDs) and Eosinophil-associated diseases (EADs) and to determine associated health care resource utilization and cost. The researchers used data from US Optum Clinformatics claims during the period 2014-2020.

EADs include such heterogenous conditions as asthma, bullous pemphigoid (BP), eosinophilic granulomatosis with polyangiitis (EGPA), eosinophilic esophagitis (EoE), eosinophilic gastritis/gastroenteritis (EG/EGE), and a subset of noncystic fibrosis bronchiectasis (NCFB), among others. The authors noted, “The underlying pathogenesis of EADs may involve eosinophilic immune dysfunction (EID), which is described as the dysregulation of biological mechanisms involved in eosinophil recruitment and activation. EAD epidemiology is complex and the extent of overlap among these conditions and the clinical impacts are poorly understood.”

The claims included were those of eligible pediatric (<18 years) and adult (≥18 years) patients with one or more EAD diagnoses and 2 years or more of continuous health plan enrollment following the first EAD claim.

Overall, 1,326,645 patients had one or more EAD of interest. Among patients with EoE (n = 13,872) and EG/EGE (n =1,365), 38% and 58%, respectively, had one or more overlapping EAD. Patients with EoE or EG/EGE tended to be younger overall —in the mid- to late 40s—than those with other rare EADs, such as BP, EGPA and NCFB, whose ages ranged from 63.9 years to 76.7 years.

“In the EoE and EG/EGE cohorts, greater overlap with other EADs was observed among patients with higher CCI [Charlson Comorbidity Index] scores and high bEOS levels (≥500 cells/µL. In the EoE group, female gender was associated with an increasing number of EAD comorbidities (EoE only: 35% female; EoE +1 EAD: 45% female; EoE +2 EADs: 55%; EoE + ≥3 EADs: 57%),” the authors wrote. “This trend did not hold true for EG/EGE.”

Patients with EAD overlap had higher total health care costs, including inpatient, outpatient, emergency room, and pharmacy costs than patients without such overlap; costs increased with the number of overlapping EADs.

“Patients with EoE or EG/EGE plus ≥1 overlapping EADs had greater disease burden than patients without any overlapping EADs,” the authors concluded. “There is a substantial need for greater awareness of EGIDs, the extent of overlap between EGIDs and other EADs, and the impacts of EAD overlap on disease burden, treatment, and healthcare utilization, all of which are critical for improving long-term outcomes for patients.”

--Rebecca Mashaw

Kwiatek J, Brailean A, Kielar D, et al. Disease burden and healthcare resource utilization in patients with eosinophilic gastrointestinal diseases (egids) with or without overlapping eosinophilic diseases in the real-world investigation of eosinophilic-associated disease overlap (REVEAL) study. Presented at: Digestive Disease Week 2022. May 21, 2022.