Lung Diseases, Interstitial
Conditions
Brief summary
The purpose of this study is to describe initiation and use of oxygen therapy among patients with fibrotic Interstitial Lung Disease (ILD) and to assess the impact of oxygen therapy on clinical outcomes among patients with fibrotic ILD.
Interventions
None listed
Sponsors
Study design
Eligibility
Inclusion criteria
* ≥2 fibrosing Interstitial Lung Disease (ILD) diagnoses in any position on different dates of service, within 365 days of each other, and in the same continuous enrollment period during the patient identification period. The fibrosing ILD diagnosis date will be defined as the date of the first fibrosing ILD diagnosis. The two fibrosing ILD diagnosis codes can be one of the following combinations: * 2 fibrosis codes * 1 fibrosis code & 1 ILD code that requires fibrosis code * ≥18 years of age as of the fibrosing ILD diagnosis date * Continuous enrollment with medical and pharmacy coverage for 12 months prior to the fibrosing ILD diagnosis date (pre-ILD baseline period)
Exclusion criteria
* Fibrosing ILD diagnosis in the 12-month pre-ILD baseline period * Unknown gender, geographic region, or insurance type
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to All-cause Mortality | Up to 2099 days (from 01 October 2016 through 30 June 2022 (patient identification period)). | Time to all-cause mortality is calculated as time between index date and mortality date. The oxygen therapy cohort index date was defined as the first date of a claim for oxygen therapy. The no oxygen therapy cohort index date was assigned as a date that was eligible to set an index date. |
| Sustained Oxygen Therapy Use Within the First 12 Months of Follow-up | Up to month 12 of follow-up, in patient identification period from 01 October 2016 through 30 June 2022. | The number of participants with ≥ 11 claims for oxygen therapy within 12 months of initiating oxygen therapy is reported. Using claims, sustained oxygen therapy use was defined among patients with at least 12 months of follow-up after the index date (oxygen initiation date), as a binary variable for the presence of ≥11 claims for oxygen therapy in a 12-month period. |
| Time to Sustained Oxygen Therapy Use | Up to 2099 days (from 01 October 2016 through 30 June 2022 (patient identification period)). | Time between the fibrosing ILD diagnosis date and the earliest date that defined the sustained oxygen therapy use is reported. Sustained oxygen therapy was defined as ≥ 11 claims for oxygen therapy within 12 months of initiating oxygen therapy. |
| Number of Participants With Disease Progression From Pre-index Forced Vital Capacity (FVC) Result to Index Date | Up to 12 months prior to the index date (between 01 October 2016 through 30 June 2022 (patient identification period)). | The Number of participants with disease progression is reported instead of time to disease progression in the Outcome Measure Data Table. Disease progression was defined as a 10% relative change between the forced vital capacity (FVC) pre-index value and the index date. |
| Number of Participants With Disease Progression From Index Date to Follow-up Forced Vital Capacity (FVC) Result | Up to month 12 of follow-up, in patient identification period from 01 October 2016 through 30 June 2022. | The Number of participants with disease progression is reported instead of time to disease progression in the Outcome Measure Data Table. Disease progression was defined as a 10% relative change between the index date to follow-up FVC result. |
| Time to Oxygen Therapy Initiation | Up to 2099 days (from 01 October 2016 through 30 June 2022 (patient identification period)). | Time from the fibrosing Interstitial Lung Disease (ILD) diagnosis date to oxygen therapy initiation is reported. Descriptive statistics are rounded to one decimal place. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Hypoxemia in the Pre-Interstitial Lung Disease (ILD) Baseline Period | Up to 12 months prior to the fibrosing ILD diagnosis date (between 01 October 2016 through 30 June 2022 (patient identification period)). | Percentage of participants with hypoxemia in the pre-ILD baseline period. The Percentage of participants is reported instead of time to hypoxemia in the Outcome Measure Data Table. The pre-ILD baseline period is defined as 12 months prior to the fibrosing ILD diagnosis date. |
| Percentage of Participants With Acute Exacerbations Within the First 12 Month of the Follow up Period | Up to 12 months post index date (between 01 October 2016 through 30 June 2022 (patient identification period)). | Percentage of participants with acute exacerbations within the first 12 month of the follow up period. The Percentage of participants is reported instead of time to acute exacerbations in the Outcome Measure Data Table. The follow up period (variable period) started on the index date until the earliest of the following: disenrollment from the health plan, death, or the end of the study period. |
| Percentage of Participants With Acute Exacerbations in the Pre-index Baseline Period | Up to 12 months prior to the index date (between 01 October 2016 through 30 June 2022 (patient identification period)). | Percentage of participants with acute exacerbations in the pre-index baseline period. The Percentage of participants is reported instead of time to acute exacerbations in the Outcome Measure Data Table. The pre-index period was defined as the 12-month period prior to the index date. The index date is the first day of follow-up observation time for Aim 2. |
| Percentage of Participants With Hypoxemia in the Pre-index Baseline Period | Up to 12 months prior to the index date (between 01 October 2016 through 30 June 2022 (patient identification period)). | Percentage of participants with hypoxemia in the pre-index baseline period. The Percentage of participants is reported instead of time to hypoxemia in the Outcome Measure Data Table. The pre-index period was defined as the 12-month period prior to the index date. The index date is the first day of follow-up observation time for Aim 2. |
Countries
United States
Participant flow
Recruitment details
This was a non-interventional study in patients with Fibrotic Interstitial Lung Disease (ILD) enrolled in a commercial, Medicaid, or Medicare plan, using existing administrative claims and Electronic Health Record (EHR) data in Optum's Market Clarity Integrated Claims + Clinical database for the period of 01 October 2015 through 30 June 2022 (study period). The patient identification period was (01-Oct-2016 through 30-Jun-2022).
Pre-assignment details
All subjects were screened for eligibility prior to participation in the trial.
Participants by arm
| Arm | Count |
|---|---|
| Patients With Fibrotic Interstitial Lung Disease (ILD) Patients aged ≥18 years with ≥2 fibrosing ILD diagnoses and continuous enrollment with medical and pharmacy coverage for 12 months prior to the fibrosing ILD diagnosis date as recorded in a commercial, Medicaid, or Medicare plan, using existing administrative claims and EHR data in Optum's Market Clarity Integrated Claims + Clinical database for the patient identification period (01-Oct-2016 through 30-Jun-2022). | 114,921 |
| Total | 114,921 |
Baseline characteristics
| Characteristic | Patients With Fibrotic Interstitial Lung Disease (ILD) |
|---|---|
| Age, Continuous | 66.9 Years STANDARD_DEVIATION 14.2 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 5455 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 78150 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 31316 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1824 Participants |
| Race (NIH/OMB) Black or African American | 11492 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 23861 Participants |
| Race (NIH/OMB) White | 77744 Participants |
| Sex: Female, Male Female | 60669 Participants |
| Sex: Female, Male Male | 54252 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 21,503 / 114,921 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Number of Participants With Disease Progression From Index Date to Follow-up Forced Vital Capacity (FVC) Result
The Number of participants with disease progression is reported instead of time to disease progression in the Outcome Measure Data Table. Disease progression was defined as a 10% relative change between the index date to follow-up FVC result.
Time frame: Up to month 12 of follow-up, in patient identification period from 01 October 2016 through 30 June 2022.
Population: Among the 24,686 fibrosing Interstitial Lung Disease (ILD) patients who initiated oxygen therapy during the Aim 1 follow-up period, 24,680 were successfully matched at a 1:1 ratio with a fibrosing ILD patient who did not yet initiate oxygen therapy.~Patients of the matched cohort are included for which pre-index and follow-up forced vital capacity (FVC) results were available.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Number of Participants With Disease Progression From Index Date to Follow-up Forced Vital Capacity (FVC) Result | 575 Participants |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Number of Participants With Disease Progression From Index Date to Follow-up Forced Vital Capacity (FVC) Result | 456 Participants |
Number of Participants With Disease Progression From Pre-index Forced Vital Capacity (FVC) Result to Index Date
The Number of participants with disease progression is reported instead of time to disease progression in the Outcome Measure Data Table. Disease progression was defined as a 10% relative change between the forced vital capacity (FVC) pre-index value and the index date.
Time frame: Up to 12 months prior to the index date (between 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Among the 24,686 fibrosing Interstitial Lung Disease (ILD) patients who initiated oxygen therapy during the Aim 1 follow-up period, 24,680 were successfully matched at a 1:1 ratio with a fibrosing ILD patient who did not yet initiate oxygen therapy.~Patients of the matched cohort are included for which pre-index and follow-up forced vital capacity (FVC) results were available.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Number of Participants With Disease Progression From Pre-index Forced Vital Capacity (FVC) Result to Index Date | 162 Participants |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Number of Participants With Disease Progression From Pre-index Forced Vital Capacity (FVC) Result to Index Date | 110 Participants |
Sustained Oxygen Therapy Use Within the First 12 Months of Follow-up
The number of participants with ≥ 11 claims for oxygen therapy within 12 months of initiating oxygen therapy is reported. Using claims, sustained oxygen therapy use was defined among patients with at least 12 months of follow-up after the index date (oxygen initiation date), as a binary variable for the presence of ≥11 claims for oxygen therapy in a 12-month period.
Time frame: Up to month 12 of follow-up, in patient identification period from 01 October 2016 through 30 June 2022.
Population: Population AIM 1 include patients newly diagnosed with fibrosing ILD during the patient identification period and met all the eligibility criteria.~Population AIM 1 in this endpoint restricted to patients with sustained oxygen therapy use within 12 months of initiating oxygen therapy patients and with ≥ 11 claims for oxygen therapy within 12 months of initiating oxygen therapy.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Sustained Oxygen Therapy Use Within the First 12 Months of Follow-up | 967 Participants |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Sustained Oxygen Therapy Use Within the First 12 Months of Follow-up | 4973 Participants |
Time to All-cause Mortality
Time to all-cause mortality is calculated as time between index date and mortality date. The oxygen therapy cohort index date was defined as the first date of a claim for oxygen therapy. The no oxygen therapy cohort index date was assigned as a date that was eligible to set an index date.
Time frame: Up to 2099 days (from 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Population AIM 2 include ILD patients with ≥1 medical claim for oxygen therapy after fibrosing ILD diagnosis of patients identified for AIM 1 and patients of AIM 1 who matched by propensity score matching (PSM) procedure.~For each oxygen therapy cohort patient, a patient who had not yet initiated oxygen therapy and with the closest available propensity score was selected.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Time to All-cause Mortality | 53.8 Months |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Time to All-cause Mortality | NA Months |
Time to Oxygen Therapy Initiation
Time from the fibrosing Interstitial Lung Disease (ILD) diagnosis date to oxygen therapy initiation is reported. Descriptive statistics are rounded to one decimal place.
Time frame: Up to 2099 days (from 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Population AIM 1 include patients newly diagnosed with fibrosing ILD during the patient identification period and met all the eligibility criteria.~Population AIM 1 in this endpoint restricted to patients without baseline oxygen therapy use.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Time to Oxygen Therapy Initiation | 27.5 Months |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Time to Oxygen Therapy Initiation | NA Months |
Time to Sustained Oxygen Therapy Use
Time between the fibrosing ILD diagnosis date and the earliest date that defined the sustained oxygen therapy use is reported. Sustained oxygen therapy was defined as ≥ 11 claims for oxygen therapy within 12 months of initiating oxygen therapy.
Time frame: Up to 2099 days (from 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Population AIM 1 include patients newly diagnosed with fibrosing ILD during the patient identification period and met all the eligibility criteria.~Population AIM 1 in this endpoint restricted to patients with sustained oxygen therapy use within 12 months of initiating oxygen therapy patients and with ≥ 11 claims for oxygen therapy within 12 months of initiating oxygen therapy.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Time to Sustained Oxygen Therapy Use | 275 Days |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Time to Sustained Oxygen Therapy Use | 266 Days |
Percentage of Participants With Acute Exacerbations in the Pre-index Baseline Period
Percentage of participants with acute exacerbations in the pre-index baseline period. The Percentage of participants is reported instead of time to acute exacerbations in the Outcome Measure Data Table. The pre-index period was defined as the 12-month period prior to the index date. The index date is the first day of follow-up observation time for Aim 2.
Time frame: Up to 12 months prior to the index date (between 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Population AIM 2 include ILD patients with ≥1 medical claim for oxygen therapy after fibrosing ILD diagnosis of patients identified for AIM 1 and patients of AIM 1 who matched by propensity score matching (PSM) procedure.~For each oxygen therapy cohort patient, a patient who had not yet initiated oxygen therapy and with the closest available propensity score was selected.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Acute Exacerbations in the Pre-index Baseline Period | 2.8 Percentage of Participants |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Acute Exacerbations in the Pre-index Baseline Period | 1.3 Percentage of Participants |
Percentage of Participants With Acute Exacerbations Within the First 12 Month of the Follow up Period
Percentage of participants with acute exacerbations within the first 12 month of the follow up period. The Percentage of participants is reported instead of time to acute exacerbations in the Outcome Measure Data Table. The follow up period (variable period) started on the index date until the earliest of the following: disenrollment from the health plan, death, or the end of the study period.
Time frame: Up to 12 months post index date (between 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Population AIM 2 include ILD patients with ≥1 medical claim for oxygen therapy after fibrosing ILD diagnosis of patients identified for AIM 1 and patients of AIM 1 who matched by propensity score matching (PSM) procedure.~For each oxygen therapy cohort patient, a patient who had not yet initiated oxygen therapy and with the closest available propensity score was selected.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Acute Exacerbations Within the First 12 Month of the Follow up Period | 3.5 Percentage of Participants |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Acute Exacerbations Within the First 12 Month of the Follow up Period | 1.6 Percentage of Participants |
Percentage of Participants With Hypoxemia in the Pre-index Baseline Period
Percentage of participants with hypoxemia in the pre-index baseline period. The Percentage of participants is reported instead of time to hypoxemia in the Outcome Measure Data Table. The pre-index period was defined as the 12-month period prior to the index date. The index date is the first day of follow-up observation time for Aim 2.
Time frame: Up to 12 months prior to the index date (between 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Population AIM 2 include ILD patients with ≥1 medical claim for oxygen therapy after fibrosing ILD diagnosis of patients identified for AIM 1 and patients of AIM 1 who matched by propensity score matching (PSM) procedure.~For each oxygen therapy cohort patient, a patient who had not yet initiated oxygen therapy and with the closest available propensity score was selected.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Hypoxemia in the Pre-index Baseline Period | 57.2 Percentage of Participants |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Hypoxemia in the Pre-index Baseline Period | 21.0 Percentage of Participants |
Percentage of Participants With Hypoxemia in the Pre-Interstitial Lung Disease (ILD) Baseline Period
Percentage of participants with hypoxemia in the pre-ILD baseline period. The Percentage of participants is reported instead of time to hypoxemia in the Outcome Measure Data Table. The pre-ILD baseline period is defined as 12 months prior to the fibrosing ILD diagnosis date.
Time frame: Up to 12 months prior to the fibrosing ILD diagnosis date (between 01 October 2016 through 30 June 2022 (patient identification period)).
Population: Population AIM 2 include ILD patients with ≥1 medical claim for oxygen therapy after fibrosing ILD diagnosis of patients identified for AIM 1 and patients of AIM 1 who matched by propensity score matching (PSM) procedure.~For each oxygen therapy cohort patient, a patient who had not yet initiated oxygen therapy and with the closest available propensity score was selected.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Hypoxemia in the Pre-Interstitial Lung Disease (ILD) Baseline Period | 19.9 Percentage of Participants |
| Non Idiopathic Pulmonary Fibrosis (IPF) Cohort | Percentage of Participants With Hypoxemia in the Pre-Interstitial Lung Disease (ILD) Baseline Period | 14.8 Percentage of Participants |