Systematic reviews and meta-analyses
Health-Related Quality of Life and Costs Associated With Eosinophilic Esophagitis: A Systematic Review

https://doi.org/10.1016/j.cgh.2017.06.036Get rights and content
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Background & Aims

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by esophageal inflammation and dysfunction. Little is known about the humanistic and economic burden of the disease on patients, their caregivers, and the health care system. A systematic review was conducted to evaluate the existing literature on the disease burden of EoE for patients and their caregivers.

Methods

The MEDLINE, Embase, and Evidence-Based Medicine Reviews databases and recent congresses were searched on March 23, 2017, for English-language publications describing the impact of EoE on health-related quality of life (HRQoL) in children and adults, and the economic burden associated with the disease.

Results

Of 676 articles identified, 22 met the inclusion criteria and were included in this analysis (HRQoL, 13; economic burden, 7; cost effectiveness, 2). The included studies showed that EoE is associated with a significant impact on HRQoL, resulting in disruption to and restrictions on daily life for patients, their caregivers, and, in some instances, their families. Treatment with topical corticosteroids, the 6-food elimination diet, or the cow’s milk elimination diet significantly improved the HRQoL of patients with EoE. Symptom severity was associated strongly with the impact of EoE on HRQoL. Medical resource utilization costs for patients with EoE were significantly higher than those for healthy controls.

Conclusions

EoE negatively impacts the HRQoL of patients and their families, and is a burden to the health care system. Although data are sparse, currently available treatments appear to improve HRQoL.

Keywords

Eosinophilic Esophagitis
Quality of Life
Esophageal Diseases

Abbreviations used in this paper

EoE
eosinophilic esophagitis
EoO-QoL-A
Adult Eosinophilic Oesophagitis Quality of Life
HRQoL
health-related quality of life
MCS
mental component summary
PedsQL
Pediatric Quality of Life Inventory
PPI
proton pump inhibitor
SF-36
36-item Short-Form Health Survey
SFED
6-food elimination diet

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e50. Learning Objective–Upon completion of this activity, successful learners will be able to interpret the current state of the published literature related to health-related quality of life and economic burden in patients with eosinophilic esophagitis.

Conflicts of interest These authors disclose the following: Vincent Mukkada has received research funding from the National Institutes of Health Patient-Centered Outcomes Research Institute, is participating in a Shire budesonide study, and is a consultant for Shire; Gary W. Falk has received research funding from Shire, Regeneron, and Celgene, and is a consultant for Adare Pharmaceuticals; Christian S. Eichinger is an employee of PharmaGenesis London, which has received funding from Shire; Denise King was an employee of Oxford PharmaGenesis at the time of the study, which has received funding from Shire; and Lora Todorova is an employee of Shire. The remaining author discloses no conflicts.

Funding Medical writing support was provided by PharmaGenesis London, UK, funded by Shire International GmbH.

© 2018 by the AGA Institute