Objectives
TNF antagonists are effective therapy for moderate to severe active Crohn's disease (CD). Despite their efficacy, these monoclonal antibodies are associated with high treatment costs. The objective was to evaluate the economic impact of the introduction of anti-TNFs for CD treatment on health care resource utilization from a health care system perspective.
Methods
A retrospective study was conducted using a random sample of patients diagnosed with CD (ICD-9=555.x) who initiated adalimumab or infliximab therapy between January 2001 and December 2009. Prescription and medical data from the Régie de l'assurance-maladie du Québec were also obtained from three samples of age- and gender-matched controls: 1) general population; 2) CD patients treated neither with anti-TNFs nor antimetabolites; and 3) CD patients taking only antimetabolites. Health care resource utilization and costs were estimated for the year preceding and following index date. Disease severity was assessed through prednisone and antimetabolite use and healthcare resource utilization in the year before index date.
Results
A cohort of 614 patients was obtained (mean age=40.5years, 61% females). Anti-TNF treated patients' average cost for health care resources was CAN$7,202. In comparison, costs in the general population, patients treated neither with anti-TNFs nor antimetabolites, and patients taking only antimetabolites, were CAN$1,093, CAN$2,029, and CAN$3,024 respectively. In the year before anti-TNF initiation, CD patients received more prednisone and antimetabolites and used more health care resources. Following anti-TNF initiation, the cost of drugs received was higher for this cohort, but costs of medical visits, ER visits and hospitalizations were significantly lower (CAN$882 vs. CAN$554, CAN$297 vs. CAN$161, and CAN$5,423 vs. CAN$2,963, respectively, p<0.001 for all).
Conclusions
Biologic users are more likely to have severe CD than controls resulting in higher medical resource consumption and greater prednisone and antimetabolites use. Initiation of a biologic treatment in these patients is associated with lower health care resource utilization and cost offsets.
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© 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
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