Economic Outcomes of Inflammatory Bowel Disease Patients Switching to a Second Anti-Tumor Necrosis Factor or Vedolizumab

Abstract

Background Anti-tumor necrosis factor (TNF) therapies have been the mainstay of inflammatory bowel disease (IBD) treatment for nearly 2 decades. Therapies with novel mechanisms of action have been recently developed. This study compared healthcare resource utilization (HRU) and costs incurred while switching from an initial anti-TNF to another anti-TNF versus switching to vedolizumab. Methods Adults with IBD who switched from initial anti-TNF to another anti-TNF or vedolizumab were identified from Truven MarketScan claims database (January 1, 2000–September 30, 2017). Patient characteristics were assessed during the 6-month period before the initiation date of the switched-to treatment (index date). Adjusted analyses of all-cause and disease-related HRU and costs during the 6-month period after the index date (study period) were performed. Anti-TNF and vedolizumab switchers with Crohn’s disease (CD) and ulcerative colitis (UC) were separately compared. Results A total of 502 vedolizumab, 1708 adalimumab, 755 infliximab, and 703 other switchers with CD and 461, 428, 311, and 148 with UC, respectively, were identified. Patient demographics were similar across cohorts. Total all-cause costs were significantly higher for vedolizumab than adalimumab, infliximab, and certolizumab switchers in the CD cohort and adalimumab and infliximab in the UC cohort. In both cohorts, adalimumab and other switchers had fewer all-cause and IBD-related outpatient visits than vedolizumab switchers. Conclusions CD/UC patients who switched to vedolizumab from initial anti-TNF had higher total and treatment costs than patients who switched to another anti-TNF, except for UC patients who switched to golimumab. Prospective studies should be conducted to confirm these findings.

A Systematic Review of the Economic and Health-Related Quality of Life Impact of Advanced Therapies Used to Treat Moderate-to-Severe Ulcerative Colitis

“…Gray horizontal arrows indicate conflicting data regarding changes in the outcome after initiation of biologic therapy (pre vs. post biologic use). a Data on direct healthcare costs were reported by four publications [ 31 , 50 , 58 , 69 ]. b Data on HCRU were reported by 10 publications [ 39 , 44 , 50 , 52 , 55 , 58 , 61 , 69 , 78 , 79 ].…”

“…a Data on direct healthcare costs were reported by four publications [ 31 , 50 , 58 , 69 ]. b Data on HCRU were reported by 10 publications [ 39 , 44 , 50 , 52 , 55 , 58 , 61 , 69 , 78 , 79 ]. ADA adalimumab, ED emergency department, GOL golimumab, HCRU healthcare resource utilization, IFX infliximab, UST ustekinumab, VDZ vedolizumab, UC ulcerative colitis, US United States …”

“…Among two USA studies, initiation of biologics was associated with reductions in mean costs of outpatient visits, hospitalizations, and emergency department visits over both 6 months and 1 year except for the initiation of vedolizumab, which was associated with increased outpatient visits [ 50 , 58 ]. There were no data reported for the USA with regard to changes in medication use or surgical procedures after biologic initiation.…”

“…Of the 40 studies, two USA studies (5.0%) assessed cost outcomes associated with biologic switching and found that changing therapies can be expensive, particularly if a different drug class is involved. Chiorean et al compared costs (2017 US$) associated with switching from one anti-TNF to another anti-TNF or vedolizumab, and found that switching to vedolizumab incurred significantly higher healthcare costs within the first 6 months after the switch versus switching to adalimumab or infliximab ($54,528 vs. $43,118–47,861, P < 0.05), but not when switching to golimumab ($54,528 vs. $49,677) [ 50 ]. These differences were driven by higher medical expenses (outpatient costs; $7768 vs. $5216, P < 0.05) and drug costs ($36,689 vs. $29,573, P < 0.05) for vedolizumab compared with adalimumab and by higher non-index drug-related pharmacy costs ($3825 vs. $2914, P < 0.05) compared with infliximab [ 50 ].…”

“…Chiorean et al compared costs (2017 US$) associated with switching from one anti-TNF to another anti-TNF or vedolizumab, and found that switching to vedolizumab incurred significantly higher healthcare costs within the first 6 months after the switch versus switching to adalimumab or infliximab ($54,528 vs. $43,118–47,861, P < 0.05), but not when switching to golimumab ($54,528 vs. $49,677) [ 50 ]. These differences were driven by higher medical expenses (outpatient costs; $7768 vs. $5216, P < 0.05) and drug costs ($36,689 vs. $29,573, P < 0.05) for vedolizumab compared with adalimumab and by higher non-index drug-related pharmacy costs ($3825 vs. $2914, P < 0.05) compared with infliximab [ 50 ]. Among patients switching anti-TNFs, Null et al found that patients treated with infliximab or adalimumab who remained on their initial anti-TNF (irrespective of dose stability) had lower mean quarterly total healthcare costs (2014 US$) versus patients who switched to the other anti-TNF ($9632–10,113 vs. $15,004) [ 56 ].…”