Prevalence and Costs of Eosinophilic Esophagitis in the United States
Authors: Hannah L Thel, Chelsea Anderson, Angela Z Xue, Elisabeth T Jensen, Evan S Dellon
Journal: Clinical Gastroenterology and Hepatology 2025
Paper of the Month – Selected and discussed by Ulrike von Arnim
🎯 Study Aim
This study aimed to estimate the current prevalence of eosinophilic esophagitis (EoE) in the United States and to quantify the associated direct healthcare costs, using large administrative claims databases.
🔬 Methods
The authors analyzed data from two large U.S. claims databases covering different observation periods: MarketScan from 2009 to 2022 and Medicare from 2009 to 2017. EoE cases were identified using ICD diagnosis codes, and age- and sex-standardized prevalence rates as well as healthcare expenditures were calculated.
📊 Key Findings
- MarketScan (2022): Estimated prevalence of~163 cases per 100,000 individuals
- Medicare (2017): Estimated prevalence of ~65 cases per 100,000 individuals
These estimates suggest that approximately 1 in 700 individuals in the U.S. population is affected, while also reflecting differences in underlying populations and non-concurrent observation periods.
Additional findings:
- EoE prevalence increased nearly fivefold since 2009
- Higher prevalence in men, peak incidence in individuals aged 40–44 years
- Estimated annual direct healthcare costs: ~USD 1.3 billion, largely driven by outpatient care and endoscopic procedures
🧠 Interpretation
The study demonstrates that EoE is no longer a rare disease and represents a growing clinical and economic burden on the healthcare system. These findings highlight the increasing relevance of EoE for healthcare planning, resource allocation, and long-term disease management strategies.
⚠️ Critical Appraisal
- Reliance on claims data: ICD-based diagnoses may result in misclassification or inaccurate prevalence estimates
- Limited clinical detail: Disease severity, histologic activity, and treatment outcomes were not captured
- Population differences & timing: MarketScan (commercially insured) and Medicare (older adults) cover different populations and observation years, limiting direct comparability
- Cost attribution: Reported costs reflect overall healthcare expenditures and may not be solely due to EoE, as comorbidities are not fully accounted for
📝 Take-Home Message
This study provides contemporary, large-scale epidemiologic data demonstrating that EoE is common and associated with substantial healthcare costs in the United States. However, due to methodological limitations inherent to claims-based analyses, the findings should be interpreted as descriptive rather than causal, emphasizing the need for clinically validated, prospective studies.