Indicators of Suboptimal Treatment and Associated Healthcare Costs Among Patients With Crohn’s Disease Initiated on Biologic or Conventional Agents

Abstract

Background As the treatment landscape for Crohn’s disease (CD) evolves, an up-to-date understanding of the burden associated with indicators of suboptimal treatment is needed. The aim of this study was todescribe suboptimal treatment indicators and associated healthcare costs among CD patients initiated on a biologic or conventional agent. Methods Adults with CD were identified in a US healthcare claims database (Optum’s Clinformatics TM Data Mart; 01/2004-03/2019). The first biologic or conventional agent claim within 12 months of a CD diagnosis was the index date/agent. Indicators of suboptimal treatment (non-adherence, dose escalation, chronic corticosteroid use, augmentation, ≥1 CD surgery, ≥2 CD emergency department visits, ≥1 CD inpatient stay, switch, cycling, restart, inadequate induction) were identified in the 12-month post-index landmark period. The mean per-patient-per-year (PPPY) healthcare costs (2019 USD) were evaluated in the year post-landmark. Results There were 5,107 patients (mean age ~44 years, 56% female) in the biologic and 6,072 patients (~51 years; 59% female) in the conventional cohort. In the biologic cohort, 79.4% of patients had ≥1 suboptimal treatment indicator. Mean PPPY healthcare costs increased with the number of suboptimal treatment indicators, from $46,100 (no indicator) to $68,572 (≥4 indicators). The conventional cohort had similar patterns: 72.5% of patients presented ≥1 suboptimal treatment indicator, and mean PPPY healthcare costs increased from $17,329 (no indicator) to $67,568 (≥4 indicators). In both cohorts, inpatient and outpatient medical costs (excluding biologics) contributed a major portion of the increase. Conclusions Among CD patients, suboptimal treatment indicators were common and were associated with an increased burden to the healthcare system.

Persistence and Dose Escalation During Maintenance Phase and Use of Nonbiologic Medications Among Patients With Ulcerative Colitis Initiated on Ustekinumab in the United States

“… 12 , 14 , 26 , 27 In this study, over 70% of patients were persistent to ustekinumab at 12 months, suggesting that some level of disease control was achieved for a substantial proportion of patients with UC reaching maintenance in the studied population. Persistence on a biologic may present additional advantages to the health system and to patients, as restart and switch can be interpreted as indicators of suboptimal treatment, which were found to be associated with higher healthcare costs 28 and reduced quality of life 25 among patients with IBD. The latter is an especially important consideration, given that in addition to improving clinical outcomes, a major goal of the treat-to-target strategy for IBD is to restore patients’ quality of life.…”

Simulated cost‐effectiveness of a novel precision‐guided dosing strategy in adult patients with Crohn's disease initiating infliximab maintenance therapy

“…Event costs were derived from a recently published claim‐based analysis 34 . This study identified cohorts of patients with CD initiated on either a biologic or conventional agent and reported incremental per patient per year cost estimates for multiple suboptimal treatment indicators; several of these indicators matched clinical events that occurred in our model.…”

“…33 Event costs were derived from a recently published claim-based analysis. 34 This study identified cohorts of patients with CD initiated on either a biologic or conventional agent and reported incremental per patient per year cost estimates for multiple suboptimal treatment indicators; several of these indicators matched clinical events that occurred in our model. Based on expert recommendation and to reflect the real-world costs of suboptimal CD treatment more accurately, we parameterized incremental medical costs (i.e., inpatient, emergency department, outpatient, and other costs) over the subsequent year for biologic patients that experienced surgery, switched biologics, or switched to CT, and CT patients that experienced surgery (Event Cost Calculations in Data S1).…”

Real-world impact of infliximab precision-guided dosing on management of patients with IBD

“…Precision-Guided Dosing on Management of Patients With IBD inadequate induction) with mean PMPY costs ranging from $46,100 (no indicator) to $68,572 (≥ 4 indicators). 10 A useful approach to biologic optimization in IBD is therapeutic drug monitoring (TDM), which involves assessing serum levels of drug and anti-drug antibodies to guide dosing decisions and to improve the probability of sustained remission. Compared with empiric changes in dosing that have been shown to lack correlation with disease activity, 11 TDM is considered to be both the standard of care and more advantageous.…”