1185 — Disparities in Utilization of Antifibrotic Medications Among U.S. Veterans with Idiopathic Pulmonary Fibrosis

Lead/Presenter: Bhavika Kaul,  San Francisco VA Measurement Science QUERI
All Authors: Kaul B (San Francisco VA Measurement Science QUERI, University of California San Francisco), Lee JS (University of Colorado) Zhang N (San Francisco VA Measurement Science QUERI, University of California San Francisco) Collard HR (University of California San Francisco) Petersen LA (Houston VA Center for Innovations In Quality, Effectiveness, and Safety, Baylor College of Medicine) Whooley MA (San Francisco VA Measurement Science QUERI, University of California San Francisco)

Objectives:
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease associated with high morbidity and mortality. In October 2014, two antifibrotic medications - pirfenidone and nintedanib - were FDA approved for treatment of IPF. However, little is known about their real-world adoption. In this study, we evaluated the rate of antifibrotic uptake and identified patient and facility level factors associated with antifibrotic utilization among U.S. Veterans with IPF.

Methods:
In this cross-sectional analysis, we used an electronic health record-based phenotype to identify patients with IPF who received care either through the VA or community care paid for by the VA. Among these Veterans, we identified patients who had filled at least one prescription for either pirfenidone or nintedanib through VA pharmacy or Medicare Part D between 10/5/2014 and 12/31/2019. We conducted mixed-effects multivariable logistic regression to examine demographic and healthcare characteristics associated with antifibrotic uptake accounting for comorbid conditions and facility level clustering, and examined disparities in medication prescribing patterns.

Results:
Among 14,792 Veterans with IPF, 17% had received antifibrotics. There were significant disparities in adoption, with significantly lower uptake associated with female sex (OR 0.31, 95% CI 0.18 – 0.52, p < 0.001), Black vs. White race (OR 0.54, 95% CI 0.44 – 0.67, p < 0.001), rural vs. urban residence (OR 0.85, 95% CI 0.77 – 0.94, p = 0.002), and older age (OR 0.93 per decade increase in age, 95% CI 0.89 – 0.97, p < 0.001). Veterans who had received their IPF diagnosis through community (vs. VA provided) care were less likely to receive antifibrotic therapy.

Implications:
The adoption of antifibrotics among Veterans with IPF has been low with significant disparities by age, sex, race, and rural residence. Veterans who received their IPF diagnosis through community (vs. VA provided) care were less likely to be prescribed antifibrotics.

Impacts:
This is the first study to evaluate the real-world adoption of antifibrotic medications among Veterans with IPF and has implications for our current subspecialty care models. The results highlight the need for increased attention on the systematic uptake of novel therapies into routine practice. The reasons for the significant disparities in uptake and interventions to address them need further investigation.