Economic and treatment burden among newly diagnosed patients with erosive esophagitis in the US: a national retrospective cohort study

Erosive esophagitis (EE) is a common complication of gastroesophageal reflux disease. Guidelines support long-term proton pump inhibitor (PPI) therapy to relieve symptoms and maintain healing of EE. Ideally, patients remain on their first line of therapy (LOT) with an effective PPI. We aimed to measure how often patients receive PPI, persistence and cycling among LOTs, and resulting healthcare resource utilization and costs. We assessed administrative claims data of patients diagnosed with EE between 0 October 2016 and 31 December 2020 using the Optum Research Database. We assessed prescribing rates of the first PPI, persistence, and rate of cycling among LOTs, health care resource utilization, and overall costs. Of 281,087 patients with EE, 178,789 had endoscopy. Overall, 27% of EE-diagnosed patients and 21% of patients in the endoscopy subgroup did not receive a PPI prescription. Among patients that did receive PPI, cycling and switching among PPIs was common, with over 50% of those patients switching to another PPI or back to a previously-used PPI after a lapse in therapy. Average total all-cause costs per patient among endoscopy patients (including patients with no record of PPI fills) were $58,692.46, and average total EE-related costs were $4304.88. Patients with EE frequently cycle and switch among PPIs. About one-fifth of patients who underwent endoscopy did not receive prescription PPI. Health care resource utilization and costs in patients with EE are substantial. PPI cycling and high discontinuation rates to PPI therapy contribute to costs associated with EE and potential delays in effective therapy.