Health-Related Quality of Life and Costs Associated With Eosinophilic Esophagitis

A Systematic Review

Vincent Mukkada; Gary W. Falk; Christian S. Eichinger; Denise King; Lora Todorova; Nicholas J. Shaheen


Clin Gastroenterol Hepatol. 2018;16(4):495-503. 

In This Article

Abstract and Introduction


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.


Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder characterized clinically by symptoms related to esophageal dysfunction, particularly dysphagia and food impaction, and histologically by eosinophil-predominant inflammation.[1] Clinical signs and symptoms of EoE vary by patient age: typically, feeding difficulties predominate in infants and toddlers, vomiting/abdominal pain in school-aged children, and dysphagia and food impaction in adolescents and adults.[1,2] The incidence and prevalence of EoE are increasing among children and adults in developed countries.[2–4] Symptoms of EoE can impact considerably on patient quality of life. However, a comprehensive overview of the effect of EoE on health-related quality of life (HRQoL) based on existing literature is lacking. Furthermore, little is known about the disease burden on patients, their caregivers, and the health care system.

This study aimed to assess systematically the humanistic and economic burden of EoE, and to obtain evidence on how the disease affects HRQoL and expenditure for patients and caregivers. The cost effectiveness of current therapies was also assessed.