Persistence with Biologic Treatment in Patients with Inflammatory Bowel Disease: A German Claims Data Analysis

Digestion ◽  
2019 ◽  
pp. 1-11 ◽  
Author(s):  
Antje Mevius ◽  
Alina Brandes ◽  
Fränce Hardtstock ◽  
Thomas Wilke ◽  
Boris A. Ratsch ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Data Analysis ◽  
Bowel Disease ◽  
Claims Data ◽  
Biologic Treatment ◽  
Inflammatory Bowel ◽  
Claims Data Analysis

scholarly journals P326 An exploratory analysis of the impact of COVID-19 on colonoscopy procedures and new biologic treatment initiation among patients with Inflammatory Bowel Disease in the United States

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S350-S351
Author(s):  
R Ungaro ◽  
B Chou ◽  
J Mo ◽  
L Ursos ◽  
R Twardowski ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Claims Data ◽  
Clinical Care ◽  
The United States ◽  
Exploratory Analysis ◽  
Biologic Treatment ◽  
Inflammatory Bowel ◽  
New Treatment ◽  
The Impact

Abstract Background Patients with inflammatory bowel disease (IBD) require frequent colonoscopies to optimize disease management and treatment strategies. At the onset of the COVID-19 pandemic, many routine procedures were postponed to reduce the overall burden on healthcare systems. We characterized the impact of COVID-19 on IBD care by conducting an exploratory analysis of real-world US healthcare claims data to identify changes in treatment patterns and the number of colonoscopy procedures performed in patients with IBD during the first wave of the pandemic. Methods De-identified, open-source health insurance claims data, from Jan 2019 to Oct 2020, were obtained from the Symphony Health Integrated Dataverse® for US adults aged 18–80 years with IBD. Four outcome measures were used: number of colonoscopies performed; number of new biologic treatment initiations or treatment switches; number of new biologic treatment initiations or treatment switches in patients who had a colonoscopy within the previous 60 days; and rate of telehealth consultations per 1000 patients per month. Results During Jan–Dec 2019 and Jan–Oct 2020, 1.54 million and 1.29 million patients with IBD, respectively, were included. The bimonthly number of colonoscopies remained stable throughout 2019, with a maximum change of +5.4% in Jul–Aug (N = 49947) vs Jan–Feb 2019 (N = 47399). Colonoscopy use decreased by 4.7% in Jan–Feb 2020 (N = 45167) vs the same period in 2019. In Mar–Apr 2020, colonoscopy numbers decreased by 55.3% (N = 20191) vs Jan–Feb 2020 (Figure 1a); a reduction of 59.4% vs Mar–Apr 2019 (N = 49780). In May–Jun 2020 (−23.8%) and Jul–Aug 2020 (+2.0%) the difference vs Jan–Feb 2020 gradually decreased (Figure 1a). Bimonthly numbers of new treatment initiations or treatment switches in 2019 varied by up to 6.9% vs Jan–Feb 2019. In May–Jun 2020, numbers of new treatment initiations or treatment switches decreased by 17.0% (N = 10072) vs Jan–Feb 2020 (N = 12133) (Figure 1b); a decrease of 19.3% vs May–Jun 2019 (N = 12488). The number of new treatment initiations or treatment switches in patients who had a colonoscopy within the previous 60 days decreased by 42.5% (N = 892) in Mar–Apr 2020 vs Jan–Feb 2020 (N = 1551) (Figure 1c); a decrease of 44.2% vs Mar–Apr 2019 (N = 1599). Telehealth utilization increased in March 2020 and remained higher than in 2019 up to October 2020 (Figure 2). Conclusion Reduction in colonoscopies and subsequent initiation/switching of treatments during the COVID-19 pandemic first wave suggests lost opportunities for therapy optimization that may have an impact on longer-term patient outcomes. Increased utilization of telehealth services may have helped address gaps in routine clinical care.

scholarly journals Persistence with biologic therapy and associated costs of patients with Inflammatory Bowel Disease: A German retrospective claims data analysis

2021 ◽  
Author(s):  
Joerg Mahlich ◽  
Melanie May ◽  
Chiara Feig ◽  
Vincent Straub ◽  
Renate Schmelz
Keyword(s):  
Data Analysis ◽  
Inpatient Treatment ◽  
Claims Data ◽  
Biologic Therapy ◽  
Biologic Agents ◽  
Treatment Costs ◽  
Biologic Agent ◽  
Biologic Treatment ◽  
Inflammatory Bowel ◽  
Claims Data Analysis

Abstract Background In recent years biologic agents became a relevant and promising treatment option for inflammatory bowel diseases (IBD). However, high treatment costs and moderate remission rates lead to a high interest in treatment persistence and corresponding economic consequences. Method A retrospective health claims data analysis was conducted including biologic naïve patients diagnosed with IBD between 2013 and 2018. Observation points were at 12 and 18 months of follow-up, starting from the first biologic prescription. Non-persistence was defined as either no further prescription or prescription of another biologic agent within the days of supply per original prescription. Biologic agents included were Adalimumab, Golimumab, Infliximab, Ustekinumab and Vedolizumab. Results In total, 1,444 patients with IBD were included in this analysis, mostly treated with Adalimumab (46.9%) and Infliximab (39.9%) as their first biologic treatment. After 12 months 72.2% of patients were still persistent with their initial biologic treatment with the highest shares for Infliximab (74%) and Vedolizumab (72.4%). 27.8% of patients were non-persistent, mostly due to a switch of biologic agent (75.8%). Cox-Regression identified sex, hospitalizations and simultaneous prescriptions of corticosteroids and immunomodulators as risk factors for non-persistence. Treatment costs per year were approximately 3,000€ higher for non-persistent patients (27,146€) than for persistent patients (23,839€), mostly due to inpatient treatment costs. Conclusion The persistence of biologic therapy in this study was rather high at 72% after 12 months, while non-persistence was mostly due to switches to other biologic agents. Lack of persistence is associated with increased cost, mostly due to non-biologic medication and inpatient treatment.

scholarly journals S775 Seroprevalence of COVID-19 in Patients With Inflammatory Bowel Disease Under Biologic Treatment

2021 ◽  
Vol 116 (1) ◽  
pp. S359-S359
Author(s):  
Isabel Garrido ◽  
Susana Lopes ◽  
Maria João Cardoso ◽  
Angélica Ramos ◽  
João Tiago Guimarães ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Biologic Treatment ◽  
Inflammatory Bowel

scholarly journals Mental Health Costs of Inflammatory Bowel Diseases

2020 ◽  
Vol 27 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Eva Szigethy ◽  
Sean M Murphy ◽  
Orna G Ehrlich ◽  
Nicole M Engel-Nitz ◽  
Caren A Heller ◽  
...  
Keyword(s):  
Mental Health ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Claims Data ◽  
The United States ◽  
Cost Of Care ◽  
Medical Utilization ◽  
Administrative Claims ◽  
Inflammatory Bowel ◽  
Ed Visits

Abstract Background Mental health diagnoses (MHDs) were identified as significant drivers of inflammatory bowel disease (IBD)-related costs in an analysis titled “Cost of Care Initiative” supported by the Crohn’s & Colitis Foundation. In this subanalysis, we sought to characterize and compare IBD patients with and without MHDs based on insurance claims data in terms of demographic traits, medical utilization, and annualized costs of care. Methods We analyzed the Optum Research Database of administrative claims from years 2007 to 2016 representing commercially insured and Medicare Advantage insured IBD patients in the United States. Inflammatory bowel disease patients with and without an MHD were compared in terms of demographics (age, gender, race), insurance type, IBD-related medical utilization (ambulatory visits, emergency department [ED] visits, and inpatient hospitalizations), and total IBD-related costs. Only patients with costs >$0 in each of the utilization categories were included in the cost estimates. Results Of the total IBD study cohort of 52,782 patients representing 179,314 person-years of data, 22,483 (42.6%) patients had at least 1 MHD coded in their claims data with a total of 46,510 person-years in which a patient had a coded MHD. The most commonly coded diagnostic categories were depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Compared with patients without an MHD, a significantly greater percentage of IBD patients with MHDs were female (61.59% vs 48.63%), older than 75 years of age (9.59% vs 6.32%), white (73.80% vs 70.17%), and significantly less likely to be younger than 25 years of age (9.18% vs 11.39%) compared with those without mental illness (P < 0.001). Patients with MHDs had significantly more ED visits (14.34% vs 7.62%, P < 0.001) and inpatient stays (19.65% vs 8.63%, P < 0.001) compared with those without an MHD. Concomitantly, patients with MHDs had significantly higher ED costs ($970 vs $754, P < 0.001) and inpatient costs ($39,205 vs $29,550, P < 0.001) compared with IBD patients without MHDs. Patients with MHDs also had significantly higher total annual IBD-related surgical costs ($55,693 vs $40,486, P < 0.001) and nonsurgical costs (medical and pharmacy) ($17,220 vs $11,073, P < 0.001), and paid a larger portion of the total out-of-pocket cost for IBD services ($1017 vs $905, P < 0.001). Conclusion Patients whose claims data contained both IBD-related and MHD-related diagnoses generated significantly higher costs compared with IBD patients without an MHD diagnosis. Based on these data, we speculate that health care costs might be reduced and the course of patients IBD might be improved if the IBD-treating provider recognized this link and implemented effective behavioral health screening and intervention as soon as an MHD was suspected during management of IBD patients. Studies investigating best screening and intervention strategies for MHDs are needed.

Real-world Pattern of Biologic Use in Patients With Inflammatory Bowel Disease: Treatment Persistence, Switching, and Importance of Concurrent Immunosuppressive Therapy

2019 ◽  
Vol 25 (8) ◽  
pp. 1417-1427 ◽  
Author(s):  
Chao Chen ◽  
Abraham G Hartzema ◽  
Hong Xiao ◽  
Yu-Jung Wei ◽  
Naueen Chaudhry ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Survival Time ◽  
Median Survival ◽  
Real World ◽  
Bowel Disease ◽  
Median Survival Time ◽  
High Rate ◽  
Biologic Treatment ◽  
Treatment Persistence ◽  
Inflammatory Bowel

Abstract Background and aims Medication persistence, defined as the time from drug initiation to discontinuation of therapy, has been suggested as a proxy for real-world therapeutic benefit and safety. This study seeks to compare the persistence of biologic drugs among patients with inflammatory bowel disease (IBD). Methods Patients with newly diagnosed IBD were included in a retrospective study using Truven MarketScan database. Treatment persistence and switching was compared among biologic medications including infliximab, adalimumab, certolizumab, golimumab, and vedolizumab. Predictors for discontinuation and switching were evaluated using time-dependent proportional hazard regression. Results In total, 5612 patients with Crohn’s disease (CD) and 3533 patients with ulcerative colitis (UC) were included in this analysis. Less than half of the patients continued using their initial biologic treatment after 1 year (48.48% in CD cohort; 44.78% in UC cohort). In the first year, adalimumab had the highest persistence and lowest switching rates for both CD (median survival time: 1.04 years) and UC (median survival time: 0.84 years). In subsequent years, infliximab users were more likely to persist in the use of biologic. Combination therapy with immunomodulators significantly decreased the risk of discontinuation, especially when immunomodulator therapy was started more than 30 days before the biologic (hazard ratio [HR], 0.22; CI, 0.16, 0.32). The major predictors for noncompliance included infection and hospitalization. Conclusion Overall, the persistence profiles of biologics suggest a high rate of dissatisfaction or adverse disease outcomes resulting in discontinuation and switching to a different agent. Early initiation of immunomodulators will substantially increase the persistence of biologic treatment.

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