How Does the Rising Cost of EpiPen Affect Patients and Providers?

Researchers sough to assess whether the cost of the EpiPen affected patient emergency department visits and length of hospital stay before and after the implementation of the Affordable Care Act.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.

NEW ORLEANS — Rising EpiPen wholesale acquisition cost (WAC) was associated with increased emergency department (ED) visits and increased in-hospital length of stay (LOS) between 2007 and 2014, according data presented at CHEST Annual Meeting 2019 held October 19 to 23, in New Orleans, Louisiana.

Researchers from Howard University Hospital in Washington, DC utilized the Nationwide Emergency Department Sample and National Inpatient Sample databases between 2006 and 2014 to extract data relating to demographics, type of insurance, ED disposition, in-hospital length of stay, in-patient mortality, intubation, and use of mechanical ventilation. The WAC of the EpiPen was defined as the manufacturer’s list price for the drug to wholesalers or direct purchases in the United States.

A total of 47,008 patients with anaphylaxis were included in the study; average patient age was 42 years and insurance coverage included Medicare (19.31%), Medicaid (16.35%), private insurance (48%), and self-pay (10.95%). The rising cost of EpiPen was associated with increased ED visits and increased length of hospital stay. After implementation of the Affordable Care Act (ACA), the rising cost of ED visits and inpatient management did not change; however, there was a decline in the length of hospital stay and the requirement for mechanical ventilation.

The total number of emergency department visits increased despite implementation of the ACA, but there was no change in mortality.

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“With ACA implementation, despite increased WAC, there was a steady decline in mean LOS, mortality and ventilation requirement,” the researchers concluded. “[Emergency department] visit cost and inpatient hospital cost continued to increase from 2007 to 2014.”

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Cousins K, Ogunti R, Ogundipe F, Mehari A. The controversy of the EpiPen: a cost-benefit analysis and what it means for care providers. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 982.