Economic implications in inflammatory bowel disease: results from a retrospective analysis in an Italian Centre
DOI:
https://doi.org/10.7175/fe.v18i1.1324Keywords:
Inflammatory Bowel Disease, Ulcerative Colitis, Crohn’s Disease, Biological drugsAbstract
BACKGROUND: Inflammatory bowel disease (IBD) represents a group of chronic conditions characterized by elevated costs. Over the last years, also a considerable healthcare burden associated with IBD has emerged, due to an increasing use of biological drugs and hospitalization costs. Despite the creation of local or regional databases, data regarding healthcare expenditure are lacking in Italy.
AIM: To evaluate the treatment cost (biological drugs and hospitalizations) for patients with ulcerative colitis (UC) or Crohn’s disease (CD) treated with biological drugs.
METHODS: Disease severity was evaluated by clinical scores (partial Mayo score and Harvey Bradshaw Index). We analyzed retrospectively patients treated with biologics referred to our IBD Unit between May 2015-April 2016 who underwent at least six months of follow-up (last visit October 2016). We calculated a mean cost per month of treatment for each patient. We also investigated the presence of any correlation between the monthly cost of treatment and demographic or clinical variables.
RESULTS: We enrolled 142 patients (52 UC, mean age 44.3 years, male 40.4%; 90 CD, mean age 38.8 years, male 56.7%). About half of CD patients (48.9%) underwent previous intestinal surgery. The disease severity was higher in UC group vs CD group. In UC group infliximab was the most prescribed biologic (51.9%), followed by golimumab (26.9%) and adalimumab (21.2%). While CD patients were treated with adalimumab in 54.4% and infliximab in 45.6%. The mean monthly cost of treatment was € 1,235.41 ± 358.38 for UC and € 1,148.92 ± 337.36 for CD (p = 0.16). In both groups expenditure due to biologics amounts for more than 80%. We found a correlation between costs and disease activity (UC: p < 0.01; CD: p < 0.01).
CONCLUSION: The main cost is due to biological drugs, but patients enrolled were the most severe in comparison to the whole IBD population under conventional therapy. As no cost differences were found between biologic drugs and the way of administration (intravenous or subcutaneous), the therapeutic choice should be driven by clinical reasons and not only economic ones.
References
Schneider Y, Saumoy M, Cohen-Mekelburg S, et al. The Cost-Effectiveness of Vedolizumab for Inflammatory Bowel Disease: A Review of the Current Literature. Gastroenterol Hepatol (NY) 2016; 12: 617-21
AMICI Onlus. Associazione Nazionale per le malattie infiammatorie corniche dell’intestino. Available at https://amiciitalia.eu/ (last accessed March 2017)
Burisch J, Munkholm P. The epidemiology of inflammatory bowel disease. Scand J Gastroenterol 2015; 50: 942-51; https://doi.org/10.3109/00365521.2015.1014407
Brunner-Suddarth. Nursing medical-surgical. 4th ed. Milano: CEA, 2010
Irvine EJ. Quality of life of patients with ulcerative colitis: past, present, and future. Inflamm Bowel Dis 2008; 14: 554-65; https://doi.org/10.1002/ibd.20301
Bodger K. Cost of illness of Crohn’s disease. Pharmacoeconomics 2002; 20: 639-52; https://doi.org/10.2165/00019053-200220100-00001
Ward FM, Bodger K, Daly MJ, et al. Clinical economics review: medical management of inflammatory bowel disease. Aliment Pharmacol Ther 1999; 13: 15-25; https://doi.org/10.1046/j.1365-2036.1999.00437.x
Bassi A1, Dodd S, Williamson P, et al. Cost of illness of inflammatory bowel disease in the UK: a single center retrospective study. Gut 2004; 53: 1471-8; https://doi.org/10.1136/gut.2004.041616
Bressler B, Marshall JK, Bernstein CN, et al. Clinical practice guidelines for the medical management of ulcerative colitis nonhospitalized: the Toronto consensus. Gastroenterology 2015; 148: 1035-58. e3
Thomas A, Lodhia N. Advanced therapy for inflammatory bowel disease: a guide for the primary care physician. J Am Board Fam Med 2014; 27: 411-20; https://doi.org/10.3122/jabfm.2014.03.130224
Danese S, Vuitton L, Peyrin-Biroulet L. Biologic agents for IBD: practical insights. Nat Rev Gastroenterol Hepatol 2015; 12: 537-45; https://doi.org/10.1038/nrgastro.2015.135
Park KT, Bass D. Inflammatory bowel disease-attributable costs and cost-effective strategies in the United States: a review. Inflamm Bowel Dis 2011; 17: 1603-9; https://doi.org/10.1002/ibd.21488
Huoponen S, Blom M. A Systematic Review of the Cost-Effectiveness of Biologics for the Treatment of Inflammatory Bowel Diseases. PLoS One 2015; 10: e0145087; https://doi.org/10.1371/journal.pone.0145087
Choy T, Jackson J. Biologic agents in the management of inflammatory bowel disease: is it worth it? UWOMJ 2012; 81:2
Mehta F. Economic Implications of Inflammatory Bowel Disease and Its Management. Am J Manag Care 2016; 22: S51-S60
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalcylic acid therapy for mildly to moderately active ulcerative colitis. N Eng J Med 1987; 317: 1625-9; https://doi.org/10.1056/NEJM198712243172603
Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005; 353: 2462-76; https://doi.org/10.1056/NEJMoa050516
Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet 1980; 315: 514; https://doi.org/10.1016/S0140-6736(80)92767-1
British Columbia Ministry of Health Services. Worksheet based on the Harvey-Bradshaw Index. British Columbia Ministry of Health Services. Available at https://www.health.gov.bc.ca/exforms/pharmacare/5374fil.pdf (last accessed Mach 2017)
Sandborn WJ, Feagan BG, Hanauer SB, et al. A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn’s disease. Gastroenterology 2002; 122: 512-30; https://doi.org/10.1053/gast.2002.31072
Interregional agreement to compensate the health mobility. Conference of Regions and Autonomous Provinces 13/41/CR05a/C7
Burisch J, Vardi H, Pedersen N, et al. Cost and resource utilization for diagnosis and treatment during the initial year in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom Study. Inflamm Bowel Dis 2015; 21: 121-31; https://doi.org/10.1097/MIB.0000000000000250
Ganz ML, Sugarman R, Wang R, et al. The Economic and Health-related Impact of Crohn’s Disease in the United States: Evidence from a Nationally Representative Survey. Inflamm Bowel Dis 2016; 22: 1032-41; https://doi.org/10.1097/MIB.0000000000000742
Gibson PR, Vaizey C, Black CM, et al. Relationship between disease severity and quality of life and assessment of health care utilization and cost for ulcerative colitis in Australia: a cross-sectional, observational study. J Crohn’s Colitis 2014; 8: 598-606; https://doi.org/10.1016/j.crohns.2013.11.017
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (see The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)
