Health Care Expenditures in Ulcerative Colitis: The Perspective of a Self-Insured Employer

Hillson, Eric; Dybicz, S; Waters, Heidi C.; Stuart, Bruce; Schaneman, Justin; Dabbous, O.; Erwin, W. Gary; Kersh, A; Broussard, Delma L.

doi:10.1097/jom.0b013e31816fd663

Cited by 17 publications

(26 citation statements)

References 26 publications

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“…[17][18][19][20] The estimated annual direct medical costs (paid by the health plans) from these studies ranged from $6217 to $11 477 per patient per year. [17][18][19][20] Hillson et al 17 used a large self-insured employer data- Although the two studies published by Hay and Hay 21,22 represent the seminal studies in the determination of the costs of inflammatory bowel diseases, they were given a low RR rating, primarily because the data are outdated. The first study by Hay and Hay 17 also used claims data from a large national insurer (Cigna Corporation) and estimated the total medical cost of UC to be $4708 in 1990 US dollars ($10 674 in 2008 US dollars).…”

Section: Direct Medical Costsmentioning

confidence: 99%

“…In the 4 studies with high RR ratings, the estimated in-patient costs ranged from $2523 to $6267 per patient per year, overall, for UC patients. [17][18][19][20] Sher et al 32 estimated the costs of hospitalizations in 40 patients with severe UC ranged from $5447 to $6412 per patient per year. The study received a low RR rating because it had a very small sample size and the data, which were from 1991 to 1995, are outdated.…”

Section: In-patient Costsmentioning

confidence: 99%

“…Studies on in-patient costs were generally consistent in their finding that hospitalization is the single largest driver of direct medical costs in the treatment of UC. In the United States, seven studies [17][18][19][20][21][22]32 reported that in-patient services accounted for 41-55% of the total direct medical costs of UC (Table 4). In the 4 studies with high RR ratings, the estimated in-patient costs ranged from $2523 to $6267 per patient per year, overall, for UC patients.…”

Section: In-patient Costsmentioning

confidence: 99%

“…In the United States, the estimated direct medical costs for UC (4 high RR studies, 2 low RR studies) [17][18][19][20][21][22] ranged from $3374 to $11 477 per patient per year ( Table 2). All four studies that received high RR ratings used claims databases and were published in 2008.…”

Section: Direct Medical Costsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review: the costs of ulcerative colitis in Western countries

Cohen

et al. 2010

Aliment Pharmacol Ther

235

151

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Section: Direct Medical Costsmentioning

confidence: 99%

Section: In-patient Costsmentioning

confidence: 99%

Section: In-patient Costsmentioning

confidence: 99%

Section: Direct Medical Costsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review: the costs of ulcerative colitis in Western countries

Cohen

et al. 2010

Aliment Pharmacol Ther

235

151

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“…The AbbVie model estimates the 2-week probability of undergoing surgery from a 1-year study reported by Hillson et al 134 This study was a retrospective analysis of medical claims with and without UC identified from a population of approximately 500,000 employees, retirees and dependants in the USA. This does not specifically relate to a moderate to severe UC population and the use of a 1-year study to estimate long-term risk is concerning, particularly given the availability of other longer studies undertaken in more relevant UC populations (see Evidence used to inform the model's parameters).…”

Section: Questionable Source Of Surgery Ratementioning

confidence: 99%

Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262): clinical effectiveness systematic review and economic model

Archer

Tappenden

Ren

et al. 2016

Health Technol Assess

143

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BackgroundUlcerative colitis (UC) is the most common form of inflammatory bowel disease in the UK. UC can have a considerable impact on patients’ quality of life. The burden for the NHS is substantial.ObjectivesTo evaluate the clinical effectiveness and safety of interventions, to evaluate the incremental cost-effectiveness of all interventions and comparators (including medical and surgical options), to estimate the expected net budget impact of each intervention, and to identify key research priorities.Data sourcesPeer-reviewed publications, European Public Assessment Reports and manufacturers’ submissions. The following databases were searched from inception to December 2013 for clinical effectiveness searches and from inception to January 2014 for cost-effectiveness searches for published and unpublished research evidence: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and NHS Economic Evaluation Database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science and Bioscience Information Service Previews. The US Food and Drug Administration website and the European Medicines Agency website were also searched, as were research registers, conference proceedings and key journals.Review methodsA systematic review [including network meta-analysis (NMA)] was conducted to evaluate the clinical effectiveness and safety of named interventions. The health economic analysis included a review of published economic evaluations and the development of a de novo model.ResultsTen randomised controlled trials were included in the systematic review. The trials suggest that adult patients receiving infliximab (IFX) [Remicade®, Merck Sharp & Dohme Ltd (MSD)], adalimumab (ADA) (Humira®, AbbVie) or golimumab (GOL) (Simponi®, MSD) were more likely to achieve clinical response and remission than those receiving placebo (PBO). Hospitalisation data were limited, but suggested more favourable outcomes for ADA- and IFX-treated patients. Data on the use of surgical intervention were sparse, with a potential benefit for intervention-treated patients. Data were available from one trial to support the use of IFX in paediatric patients. Safety issues identified included serious infections, malignancies and administration site reactions. Based on the NMA, in the induction phase, all biological treatments were associated with statistically significant beneficial effects relative to PBO, with the greatest effect associated with IFX. For patients in response following induction, all treatments except ADA and GOL 100 mg at 32–52 weeks were associated with beneficial effects when compared with PBO, although these were not significant. The greatest effects at 8–32 and 32–52 weeks were associated with 100 mg of GOL and 5 mg/kg of IFX, respectively. For patients in remission following induction, all treatments except ADA at 8–32 weeks and GOL 50 mg at 32–52 weeks were associated with beneficial effects when compared with PBO, although only the effect of ADA at 32–52 weeks was significant. The greatest effects were associated with GOL (at 8–32 weeks) and ADA (at 32–52 weeks). The economic analysis suggests that colectomy is expected to dominate drug therapies, but for some patients, colectomy may not be considered acceptable. In circumstances in which only drug options are considered, IFX and GOL are expected to be ruled out because of dominance, while the incremental cost-effectiveness ratio for ADA versus conventional treatment is approximately £50,300 per QALY gained.LimitationsThe health economic model is subject to several limitations: uncertainty associated with extrapolating trial data over a lifetime horizon, the model does not consider explicit sequential pathways of non-biological treatments, and evidence relating to complications of colectomy was identified through consideration of approaches used within previous models rather than a full systematic review.ConclusionsAdult patients receiving IFX, ADA or GOL were more likely to achieve clinical response and remission than those receiving PBO. Further data are required to conclusively demonstrate the effect of interventions on hospitalisation and surgical outcomes. The economic analysis indicates that colectomy is expected to dominate medical treatments for moderate to severe UC.Study registrationThis study is registered as PROSPERO CRD42013006883.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Inflammatory bowel disease-attributable costs and cost-effective strategies in the United States

Park

Bass

2011

Inflammatory Bowel Diseases

119

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The United States spends more for healthcare than any other country in the world. With the rising prevalence of both Crohn's disease and ulcerative colitis, inflammatory bowel disease (IBD) represents the leading chronic gastrointestinal disease with increasing healthcare expenditures in the US. IBD costs have shifted from inpatient to outpatient care since the introduction of biologic therapies as the standard of care. Gastroenterologists need to be aware of the national cost burden of IBD and clinical practices that optimize cost-efficiency. This investigation offers a systematic review of the economics of IBD and evidence-based strategies for cost-effective management.

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Health Care Expenditures in Ulcerative Colitis: The Perspective of a Self-Insured Employer

Abstract: UC is a significant predictor of increased medical costs with severe disease, driven mainly by inpatient costs.

Cited by 17 publications

References 26 publications

Systematic review: the costs of ulcerative colitis in Western countries

Systematic review: the costs of ulcerative colitis in Western countries

Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262): clinical effectiveness systematic review and economic model

Inflammatory bowel disease-attributable costs and cost-effective strategies in the United States

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