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Implementing an interstitial lung disease clinic improves survival without increasing health care resource utilization

Povitz M, Li L, Hosein K, Shariff S, Mura M. Pulm Pharmacol Ther. 2019; 56:94-9. Epub 2019 Mar 29. DOI: http://doi.org/10.1016/j.pupt.2019.03.012


Background — Multidisciplinary collaboration is the cornerstone of interstitial lung disease (ILD) care. Delayed access to specialized care is associated with worse outcome. At the same time, the economic burden of ILD is high. We hypothesized that the establishment of a regional, dedicated ILD clinic would improve survival, but without necessarily causing an increase of health care resource utilization (HRU).

Methods — A historic cohort (January 2000-June 2013, n = 127) and a specialized care cohort followed by a dedicated ILD clinic (July 2013-June 2016, n = 144) were compared. Patients with idiopathic pulmonary fibrosis were excluded, due to the impact of new anti-fibrotic agents. Patients' data were linked to multiple provincial health administrative datasets. HRU included hospitalizations, doctor and emergency visits, pulmonary (including chest x-ray, chest CT scans, pulmonary function tests, bronchoscopies), cardio-vascular investigations, and specific ILD therapies. HRU was calculated as annual rate by domain. Three-year survival from initial assessment was the secondary outcome.

Results — The 2 cohorts were closely comparable in terms of specific ILD diagnosis, baseline lung function, comorbidities, neighbourhood income. There were overall no significant differences in terms of HRU. In the specialized care cohort, the use of non-steroid immunosuppressive therapies increased and survival significantly improved, despite significantly older age of patients at the time of initial assessment. Specialized ILD care was independently protective towards survival.

Conclusions — Specialized, multi-disciplinary ILD care in a dedicated regional clinic is associated with improved survival and does not cause an increase of HRU, supporting the institution of potentially more cost-effective care with specialized ILD clinics.

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