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.