Abstract
Purpose: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease requiring long-term management. Loss to follow-up (LTFU) is a significant issue, leading to increased complications and higher healthcare costs. One key factor contributing to LTFU is the lack of structured transition models for patients moving from pediatric to adult care. This study provides the first model-based economic evaluation of LTFU in EoE within the Italian National Healthcare Service (NHS) and aims to quantify the economic impact of LTFU as well as evaluate the potential cost reduction associated with implementing a structured transition model. Patients and Methods: A health economic model was developed to assess the financial burden of LTFU in EoE from the perspective of the Italian NHS. The model incorporated epidemiological, clinical, and economic inputs, estimating, within a time-horizon of one year, the economic burden of LTFU and the cost differential between patients with continuous care and those experiencing a care gap (>= 2 years). The analysis included costs related to emergency department (ED) visits, hospitalizations, pharmacological treatments, and outpatient services. All costs were reported in 2024 euros. Additionally, a simulation was conducted to evaluate the potential economic benefits of a structured transition model. Results: The total economic burden of LTFU in EoE was estimated at & euro; 84.9 million, with an average cost per patient of & euro; 15,468, nearly double the cost of patients receiving continuous care (& euro; 7,744). The primary cost drivers were hospitalizations (69%) and pharmacological treatments (30%). The introduction of a transition model reducing LTFU by 30% could result in a & euro; 25.4 million cost reduction, primarily through decreased hospital admissions and optimized treatment strategies. Conclusion: LTFU in EoE is associated with a significant economic burden. Implementing a structured transition model could improve patient retention, enhance adherence to treatment, and generate important cost savings.