Use of rhDNase therapy and costs of respiratory-related care in patients with cystic fibrosis

OBJECTIVE: To assess the relationship between level of use of recombinant d eoxyribonuclease I (rhDNase) therapy and costs of respiratory related care in patients with cystic fibrosis. DESIGN: Retrospective, cohort study using healthcare claims data from a lar ge New England health insurer. PATIENTS: All cystic fibrosis patients five years of age and older who bega n therapy with rhDNase in 1994 (the year it was first marketed in the US). Healthcare claims were compiled for six months prior to first receipt of rh DNase (pretreatment) and for 30 months subsequently (follow-up). Patients w ere stratified according to their level of rhDNase use during follow-up, ba sed on whether it was above or below the median number of therapy days for the sample. MAIN OUTCOME MEASURES: Costs of rhDNase, all antibiotics, and all respiratr oy-related outpatient (physician, home health, hospital outpatient) and inp atient care were included. All costs were expressed on an annulaized basis. RESULTS: Twenty-four patients with cystic fibrosis who began treatment with rhDNase in 1994 met all entry criteria: the median number of therapy days over a 30-month period was 355. Among patients with low (i.e., below the me dian) rhDNase use (n = 12), mean +/- SD annualized costs of respiratory-rel ated care increased by almost $17 000 between pretreatment and follow-up, f rom $29 251 +/- $37 919 to $46 109 +/- $40 944. Among high-use patients (n = 12), costs decreased by approximately $2500, from $37 178 +/- $48 476 to $34 592 +/- $22 591. The change in both groups was accounted for primarily by a change in the number of respiratory-related hospitalizations. CONCLUSIONS: Prolonged use of rhDNase may reduce costs of respiratory-relat ed care in patients with cystic fibrosis; further study is related hospital izations.