Direct health-care cost utilization in Hong Kong inflammatory bowel disease patients in the initial 2 years following diagnosis

Abstract Background Tumor necrosis factor-alpha inhibitors (anti-TNFs) are a primary treatment for inflammatory bowel disease. Pharmaceutical expenditures and usage of specialty drugs are increasing. In the United States, biosimilars continue to be underutilized, despite opportunities for health care cost savings. Through quality improvement (QI) methodology, we aimed to increase biosimilar utilization among eligible patients initiating intravenous (IV) anti-TNF therapy and describe patient outcomes and associated cost savings. Methods Beginning in July 2019, all patients initiating IV anti-TNF therapy were identified and tracked. Using the Institute of Healthcare Improvement Plan-Do-Study-Act cycle, a four-stage problem-solving model used for carrying out change, we trialed interventions to increase biosimilar utilization, including provider, staff, and family education, and utilization of a clinical pharmacist and insurance specialist. Statistical process control charts were used to show improvement over time. Patients’ clinical outcome and cost savings were reviewed. Results Using QI methodology, we increased biosimilar utilization from a baseline of 1% in June 2019 to 96% by February 2021, with sustained improvement. The originator (infliximab) was the insurance company’s preferred product for 20 patients (20%). Patient outcomes (IV anti-TNF levels, absence of antidrug antibodies, and physician global assessment) between biosimilars and originators were similar. Estimated cost savings over the project duration were nearly $381,000 (average sales price) and $651,000 (wholesale acquisition cost). Conclusions Through QI methodology, we increased biosimilar utilization from 1% to 96% with sustained improvement, without compromising patient outcomes or safety. Estimated cost savings were substantial. Similar methodology could be implemented at other institutions to increase biosimilar utilization and potentially decrease health care costs.

Download Full-text

Health Care Cost Analysis in a Population-based Inception Cohort of Inflammatory Bowel Disease Patients in the First Year of Diagnosis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjv117 ◽

2015 ◽

Vol 9 (11) ◽

pp. 988-996 ◽

Cited By ~ 28

Author(s):

Olga Niewiadomski ◽

Corrie Studd ◽

Christopher Hair ◽

Jarrad Wilson ◽

John McNeill ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Cost Analysis ◽

Bowel Disease ◽

Health Care Cost ◽

Population Based ◽

First Year ◽

Inception Cohort ◽

Inflammatory Bowel

Download Full-text

Real-world biologic treatment and associated cost in patients with inflammatory bowel disease

Zeitschrift für Gastroenterologie ◽

10.1055/a-0903-2938 ◽

2019 ◽

Vol 57 (07) ◽

pp. 843-851 ◽

Cited By ~ 3

Author(s):

Alina Brandes ◽

Antje Groth ◽

Fraence Gottschalk ◽

Thomas Wilke ◽

Boris A. Ratsch ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Biologic Therapy ◽

Health Care Cost ◽

Maintenance Phase ◽

Biologic Treatment ◽

Tnf Α ◽

Inflammatory Bowel ◽

The Mean

Abstract Objectives This study aimed to describe biologic treatment of German inflammatory bowel disease (IBD) patients, including biologics’ dosage, health care resource use, and treatment-associated cost. Methods In this retrospective claims data analysis, all continuously insured adult IBD patients (Crohnʼs disease [CD] or ulcerative colitis [UC]) who started a new therapy with an anti-tumor necrosis factor alpha (anti-TNF-α) or vedolizumab (VDZ) were included. Observation started with the date of the first prescription of index biologic therapy and lasted 12 months. Results In the database, 1248 out of 57 296 IBD patients started a biologic treatment of interest (1020 anti-TNF-α, 228 VDZ), and 837 patients were bio-naïve (773 anti-TNF-α, 64 VDZ). The mean age of bio-naïve/bio-experienced anti-TNF-α patients was 39.2/38.1 years (54.9 %/56.7 % female) and 42.6/37.8 years for VDZ patients (56.3 %/54.9 % female). The proportion of patients receiving a maintenance dosage > 150 % compared to SmPC was 15.1 % for Adalimumab, 5.2–39.0 % for Golimumab, 14.7–34.5 % for Infliximab, and 19.7 % for VDZ patients. During the maintenance phase, up to 58.8 % of patients received at least 1 prescription of any CS, and 41.7 %/47.1 % (anti-TNF-α/VDZ) were treated in a hospital due to IBD. The mean IBD-related direct health care cost per patient year was € 30 246 (anti-TNF-α)/ € 28 227 (VDZ) for bio-naïve patients (p = 0.288) and € 34 136 (anti-TNF-α)/ € 32 112 (VDZ) for bio-experienced patients (p = 0.011). Conclusions A substantial percentage of patients receive a high biologic dosage in the maintenance phase. Despite biologic therapy, 30–40 % receive a CS therapy and/or experience at least 1 IBD-associated hospitalization within a year, possibly indicating a remaining disease activity.

Download Full-text

Increasing Prevalence and Direct Health Care Cost of Inflammatory Bowel Disease Among Adults: A Population-Based Study From a Western Canadian Province

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab003 ◽

2021 ◽

Author(s):

Jessica Amankwah Osei ◽

Juan Nicolás Peña-Sánchez ◽

Sharyle A Fowler ◽

Nazeem Muhajarine ◽

Gilaad G Kaplan ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Costs ◽

Bowel Disease ◽

Health Care Cost ◽

Population Based ◽

Annual Increase ◽

Average Annual Increase ◽

Inflammatory Bowel ◽

Care Costs

Abstract Objectives Our study aimed to calculate the prevalence and estimate the direct health care costs of inflammatory bowel disease (IBD), and test if trends in the prevalence and direct health care costs of IBD increased over two decades in the province of Saskatchewan, Canada. Methods We conducted a retrospective population-based cohort study using administrative health data of Saskatchewan between 1999/2000 and 2016/2017 fiscal years. A validated case definition was used to identify prevalent IBD cases. Direct health care costs were estimated in 2013/2014 Canadian dollars. Generalized linear models with generalized estimating equations tested the trend. Annual prevalence rates and direct health care costs were estimated along with their 95% confidence intervals (95%CI). Results In 2016/2017, 6468 IBD cases were observed in our cohort; Crohn’s disease: 3663 (56.6%), ulcerative colitis: 2805 (43.4%). The prevalence of IBD increased from 341/100,000 (95%CI 340 to 341) in 1999/2000 to 664/100,000 (95%CI 663 to 665) population in 2016/2017, resulting in a 3.3% (95%CI 2.4 to 4.3) average annual increase. The estimated average health care cost for each IBD patient increased from $1879 (95%CI 1686 to 2093) in 1999/2000 to $7185 (95%CI 6733 to 7668) in 2016/2017, corresponding to an average annual increase of 9.5% (95%CI 8.9 to 10.1). Conclusions Our results provide relevant information and analysis on the burden of IBD in Saskatchewan. The evidence of the constant increasing prevalence and health care cost trends of IBD needs to be recognized by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.

Download Full-text

P771 Increasing prevalence and direct health care cost of inflammatory bowel disease: A population-based evidence from a western Canadian province

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.899 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S611-S612

Author(s):

J A Osei ◽

J N Peña-Sánchez ◽

S A Fowler ◽

N Muhajarine ◽

G Kaplan ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Costs ◽

Bowel Disease ◽

Health Care Cost ◽

Population Based ◽

Canadian Province ◽

Annual Increase ◽

Inflammatory Bowel ◽

Care Costs

Abstract Background More than 0.3% of the populations in Europe, North America, and Oceania live with inflammatory bowel disease (IBD). Canada has increasing prevalence trends of IBD with 1% of Canadians estimated to have IBD by 2030. Evidence about IBD prevalence and health care costs over time can contribute to health resources allocation and health care planning. Our study aimed to 1) estimate the prevalence and direct health care costs of IBD in the province of Saskatchewan (SK), Canada, and 2) test if trends in the prevalence and direct health care costs of IBD increased over two decades. Methods We conducted a retrospective population-based cohort study using administrative health data of SK between 1999/00 and 2016/17 fiscal years. A validated case definition was used to identify prevalent IBD cases. The costing method adopted by the Canadian Institute for Health Information was used to estimate direct health care costs in 2013/14 Canadian dollars among IBD cases. Generalised linear models (GLMs) with generalised estimating equations were used to test the trends. Negative binomial and gamma distributions were used to, respectively, model prevalence and health care cost trends. Sex and age group were covariates in all models; the Charlson comorbidity index was also included in the cost model. Annual prevalence rates and direct health care cost estimates with their 95% confidence intervals (95%CI) were reported. Results In 2016, there were 6468 (Crohn’s disease: 3663 [56.63%], ulcerative colitis: 2805 [43.37%]) IBD cases ascertained in SK. The number of prevalent cases increased over the analysis period by 56%. The total direct health care costs increased from $7.8 million in 1999 to $50.8 million in 2016. The average annual IBD prevalence increased from 341/100,000 (95%CI 340–341) in 1999 to 664/100,000 (95%CI 663–665) in 2016, a 3.3% (95%CI 2.4–4.3) average annual increase. The total average annual direct health care costs of IBD increased from $1.8 (95%CI $1.6–2.0) thousand per patient in 1999 to $7.1 (95%CI $6.7–7.5) thousand per patient in 2016, an average annual increase of 9.2% (95% CI 8.5–9.8), Figure 1. Conclusion In the Canadian province of SK, prevalence and direct health care costs, respectively, tripled and quadrupled over two decades. Our results provide relevant information and analysis on the burden of IBD in SK. These findings are in agreement with previous studies from other provinces. The evidence of constant increasing prevalence and health care cost trends of IBD needs to be recognised by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.

Download Full-text

P373 Telemedicine and inflammatory bowel disease: Results of the IBD assistant pilot project

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.502 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S352-S353

Author(s):

K Malickova ◽

V Pesinova ◽

M Bortlik ◽

D Duricova ◽

N Machkova ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Health Care Cost ◽

Controlled Study ◽

Ctrl Group ◽

Outpatient Visits ◽

Significant Difference ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Telemedicine enables proper and immediate monitoring of the patient’s current health state, followed by well-timed and customised treatment. The aim of our study was to assess feasibility and safety of telemonitoring in Czech patients with inflammatory bowel disease (IBD). Furthermore, we wanted to evaluate the impact of telemonitoring on the number of outpatient′s visits and direct health-care cost. Methods We performed randomised controlled study including patients with IBD in stable remission on conventional therapy who were randomised either to telemonitoring (IBDA) or control (CTRL) group and were followed-up for 12 months. All IBDA patients had access to a specific web application which contained a set of questioners assessing disease activity and complications which were filled-in at least every 3 months. Evaluation of clinical activity was accompanied by measurement of faecal calprotectin (FC) at home using CalproSmart test. Individuals in the CTRL group were followed under the standard conditions as other outpatients. Results A total of 131 were included (42% males; 47% with Crohn′s disease) and randomised to IBDA (n = 94) or control group (n = 37). HBI/pMayo activity indexes were not significantly different at baseline (p = 0.636 and p = 0.853) and end of study (p = 0.517 and p = 0.890) in the two groups. Similarly, no significant difference in inflammatory markers (C-reactive protein, FC) was observed in either group (p>0.05). The occurrence of intercurrent infections (0.93 vs. 0.81 cases of infection/patient-year, p = 0.87) or the need for hospitalisations (1 vs. 0) was similar between the groups. The number of outpatient visits was significantly lower in the IBDA than in the CTRL group (median number in IBDA group 0, in the CTRL group 4.2 visits, respectively, p < 0.0001). Telemedicine led to a reduction in the direct annual health-care cost of patient follow-up by ~25% compared with the standard care. Conclusion Results of the first Czech IBD telemedicine study confirm the effectiveness and safety of the telemedicine approach, which led to a reduction in outpatient visits and savings in health-care costs while maintaining a high standard of health care. Acknowledgements: Supported by the IBD-Comfort Endowment Fund.

Download Full-text

Sa512 URBAN-RURAL DIFFERENCES IN HEALTH CARE UTILIZATION FOR INFLAMMATORY BOWEL DISEASE IN THE UNITED STATES, 2017

Gastroenterology ◽

10.1016/s0016-5085(21)01968-5 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-529-S-530

Author(s):

Fang Xu ◽

Susan Carlson ◽

Kurt Greenlund

Keyword(s):

United States ◽

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Utilization ◽

Bowel Disease ◽

The United States ◽

Care Utilization ◽

Urban Rural ◽

Inflammatory Bowel

Download Full-text

A183 TELEHEALTH USE IN RURAL SASKATCHEWAN AND INFLAMMATORY BOWEL DISEASE OUTCOMES

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.181 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 197-199

Author(s):

M Patterson ◽

M Gozdzik ◽

J Peña-Sánchez ◽

S Fowler

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Utilization ◽

Bowel Disease ◽

Postal Code ◽

Care Utilization ◽

Specialist Care ◽

Disease Characteristics ◽

Significant Difference ◽

Inflammatory Bowel

Abstract Background Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient’s personal phones. Aims The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods A retrospective chart review was completed on all rural patients (postal code S0*) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups; although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05). Conclusions Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care. Funding Agencies None

Download Full-text