Evolution of Costs of Inflammatory Bowel Disease over Two Years of Follow-Up

Abstract

BackgroundWith the increasing use of anti-TNF therapy in inflammatory bowel disease (IBD), a shift of costs has been observed with medication costs replacing hospitalization and surgery as major cost driver. We aimed to explore the evolution of IBD-related costs over two years of follow-up.Methods and FindingsIn total 1,307 Crohn's disease (CD) patients and 915 ulcerative colitis (UC) patients were prospectively followed for two years by three-monthly web-based questionnaires. Changes of healthcare costs, productivity costs and out-of-pocket costs over time were assessed using mixed model analysis. Multivariable logistic regression analysis was used to identify costs drivers. In total 737 CD patients and 566 UC were included. Total costs were stable over two years of follow-up, with annual total costs of €7,835 in CD and €3,600 in UC. However, within healthcare costs, the proportion of anti-TNF therapy-related costs increased from 64% to 72% in CD (p<0.01) and from 31% to 39% in UC (p < 0.01). In contrast, the proportion of hospitalization costs decreased from 19% to 13% in CD (p<0.01), and 22% to 15% in UC (p < 0.01). Penetrating disease course predicted an increase of healthcare costs (adjusted odds ratio (adj. OR) 1.95 (95% CI 1.02–3.37) in CD and age <40 years in UC (adj. OR 4.72 (95% CI 1.61–13.86)).ConclusionsBD-related costs remained stable over two years. However, the proportion of anti-TNF-related healthcare costs increased, while hospitalization costs decreased. Factors associated with increased costs were penetrating disease course in CD and age <40 in UC.

Market share and costs of biologic therapies for inflammatory bowel disease in the USA

“…5 As a result of increasing biologics use, overall costs of medical care have shifted from acute care services to out-patient pharmacy utilization, 6 with recent evidence suggesting pharmacy costs account for nearly one-half of all disease-related direct expenditures. [7][8][9] This trend in prescription drug costs outpacing all other segments of healthcare is consistent across other chronic diseases. 10,11 Compared to other medication classes, namely 5-ASAs, immunomodulators (mercaptopurine, azathioprine, and methotrexate), and corticosteroids, biologics use represents an increasing impact to rising health care costs in IBD.…”

“…7,8,9 This trend in prescription drug costs outpacing all other segments of healthcare is consistent across other chronic diseases. 10,11 Compared to other medication classes, namely 5-ASAs, immunomodulators (mercaptopurine, azathioprine, and methotrexate), and corticosteroids, biologics use represents an increasing impact to rising health care costs in IBD.…”

HLA-DQA1*05 is associated with the development of antibodies to anti-TNF therapy

“…As a result, we might have underestimated rates of immunogenicity amongst adalimumab-treated patients. Finally, unlike the registration trials, 2,34,35 we did not employ real-time monitoring.…”

Path of Interchangeability of Biosimilars in Pediatric Inflammatory Bowel Disease

“…More recent studies show that pharmacy utilization costs, driven mainly by biologics use, are primary drivers of IBD economics, outpacing acute care costs, including hospitalizations (1, 2). Consequently, the anticipated advent of biosimilars represents the potential to generate cost savings and increase patient access to necessary treatment.…”