scholarly journals The cost burden of Crohn’s disease and ulcerative colitis depending on biologic treatment status – a Danish register-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Alulis ◽  
Kasper Vadstrup ◽  
Jens Olsen ◽  
Tine Rikke Jørgensen ◽  
Niels Qvist ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Healthcare Costs ◽  
Treatment Initiation ◽  
Annual Production ◽  
First Year ◽  
Biologic Treatment ◽  
Production Values ◽  
Average Annual Production

Abstract Background Patients diagnosed with inflammatory bowel disease may be treated with biologics, depending on several medical and non-medical factors. This study investigated healthcare costs and production values of patients treated with biologics. Methods This national register study included patients diagnosed with Crohn’s disease (CD) and ulcerative colitis (UC) between 2003 and 2015, identified in the Danish National Patient Register (DNPR). Average annual healthcare costs and production values were compared for patients receiving biologic treatment or not, and for patients initiating biologic treatment within a year after diagnosis or at a later stage. Cost estimates and production values were based on charges, fees and average gross wages. Results Twenty-six point one percent CD patients and ten point seven percent of UC patients were treated with biologics at some point in the study period. Of these, 46.4 and 45.5 % of patients initiated biologic treatment within the first year after diagnosis. CD and UC patients treated with biologics had higher average annual healthcare costs after diagnosis compared to patients not treated with biologics. CD patients receiving biologics early had lower production values both ten years before and eight years after treatment initiation, compared to patients receiving treatment later. UC patients receiving biologics early had lower average annual production values the first year after treatment initiation compared to UC patients receiving treatment later. Conclusions CD and UC patients receiving biologic treatment had higher average annual healthcare costs and lower average annual production values, compared to patients not receiving biologic treatment. The main healthcare costs drivers were outpatient visit costs and admission costs.

scholarly journals P800 Treatment patterns for biologics in ulcerative colitis and Crohn’s disease: A Danish Nationwide Register Study from 2003 to 2015

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S628-S628 ◽  
Author(s):  
S Alulis ◽  
K Vadstrup ◽  
A Borsi ◽  
A Nielsen ◽  
T Rikke Jørgensen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Severe Disease ◽  
Treatment Patterns ◽  
Register Study ◽  
First Year ◽  
Biologic Treatment ◽  
Number Of Patients ◽  
Nationwide Register Study

Abstract Background The choice of biological treatment for Crohn’s disease (CD) and Ulcerative Colitis (UC) depends on disease severity and possible other factors. Patients with moderate to severe disease should be prescribed biologic response modifiers (biologics), according to guidelines. This study aims to explore the treatment patterns of patients diagnosed with CD and UC. Methods This national register study included patients diagnosed between 2003 and 2015, identified in the Danish National Patient Registry (NPR). Biologic therapies available during the study period were infliximab, adalimumab, vedolizumab and golimumab. The share of patients initiating and receiving biologic treatment in each year was calculated. Additionally, the time from IBD diagnosis to first biologic treatment and time between treatments were calculated. Results Among 10,302 CD patients and 22,144 UC patients, 28.5% of CD patients and 11.3% of UC patients received treatment with biologics during the study period, with an increasing number of patients initiating treatment with biologics for each successive year. 46% of CD and 45% of UC patients in the study population received their first biologic treatment within the first year after IBD diagnosis. 57–68% of CD and UC patients started treatment with their second line biologic within two months of the last treatment with their first line. Conclusion The number of patients initiating biologic treatments after diagnosis increased throughout the study period. Approximately half of patients diagnosed with CD and UC are receiving biologic treatments within the first year after diagnosis.

scholarly journals P798 Societal costs attributable to Crohn’s disease and ulcerative colitis within the first 5 years after diagnosis: –a Danish Nationwide Cost-of-Illness Study 2003–2015

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S627-S627
Author(s):  
S ALULIS ◽  
K Vadstrup ◽  
A Borsi ◽  
S Elkjær Stallknecht ◽  
J Olsen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
General Population ◽  
Hospital Admission ◽  
Cost Of Illness ◽  
Control Group ◽  
First Year ◽  
Production Loss ◽  
Societal Costs

Abstract Background There is little information on cost-of-illness among patients diagnosed with Crohn’s disease (CD) and ulcerative colitis (UC) in Denmark. The objective of this study was to estimate the average 5-year societal costs attributable to CD or UC including costs related to health care, prescription medicine, home care, and production loss. Methods Incident patients with CD or UC were identified in the National Patient Registry and matched with a non-IBD control from the general population on age and sex. Attributable costs were estimated applying a difference-in-difference approach, where the total costs among individuals in the control group were subtracted from the total costs among patients. Information on primary and secondary healthcare services were obtained from the National Health Insurance Service Registry. Results CD and UC incidence was approximately 14 and 31 per 100,000 persons-years, respectively. Average attributable costs were highest the first year after diagnosis, with costs equalling €12,919 per CD patient and €6,501 per UC patient. Hospital admission costs accounted for 36% in the CD population and 31% in the UC population, the first year after diagnosis. Production loss exceeded all other costs the third year after diagnosis. Conclusion We found that the societal costs attributable to incident CD and UC patients are substantial compared with the general population, primarily consisting of hospital admission costs and production loss. Appropriate treatment at the right time may be beneficial from a societal perspective.

scholarly journals DOP21 Time to first treatment with biologic agents for ulcerative colitis and Crohn’s disease across four Nordic countries: Results from the TRINordic study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S060-S061
Author(s):  
M Høivik ◽  
M Lördal ◽  
J Burisch ◽  
E Langholz ◽  
T Knudsen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Nordic Countries ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Biologic Agent ◽  
Patient Registries ◽  
Biologic Treatment

Abstract Background Real-world data on time from diagnosis to first biologic treatment is limited for ulcerative colitis (UC) and Crohn’s disease (CD) patient populations. Methods This retrospective observational study collected data from the National Patient Registries and National Prescription Registries in Sweden (data on biologic use was only available for Stockholm [STK], Norway [NOR], Denmark [DEN]) and one university hospital database (Turku, Finland [FIN]) during 2010–2017 to investigate time from diagnosis to first biologic treatment for UC and CD. Patients with ≥2 ICD-10 diagnosis codes for UC (K51) or CD (K50) from 2010 or later were included; patients were classified according to their last code. The look-back period for SWE was until 2000, for NOR until 2008, for DEN until 1995, and for FIN until 2004. Time to first biologic was defined as the period from the first UC or CD code to first biologic record. In FIN, it was only possible to investigate infliximab (IFX). Results A total of 47,568 patients were included (STK n = 5594, NOR n = 20,761, FIN n = 2118, DEN n = 19,095). Of them, 30 397 patients had UC and 17 171 CD diagnosed during 2010–2017. Time to first biologic following diagnosis of UC or CD was decreased over time. For patients diagnosed with CD in 2015, in STK, NOR, FIN, and DEN, 30%, 35%, 25%, and 26%, respectively, received a biologic within 2 years; in 2010, the proportions were less than 10%, 20%, 5%, and 22%, respectively. FIN results may be attributed to only IFX use captured in the data sources. NOR had in most cohorts the shortest time between diagnosis and first treatment with a biologic agent, e.g. 33%, 35%, 36%, 34% and 33% of patients diagnosed with CD in 2011, 2012, 2013, 2014 and 2015, respectively, received a biologic already one month after diagnosis compared with 2%, 1%, 3%, 4% and 6%, respectively, in STK, 7%, 5%, 9%, 4% and 5%, respectively, in FIN and 3%, 10%, 28%, 12% and 23%, respectively, in DEN. Fewer UC than CD patients received biologics, but the time to first biologic was shortened to the same extent (Figure 1 and 2, respectively). In NOR, FIN and DEN, the most common biologic used was IFX for UC and CD, e.g. 18%, 14% and 15%, respectively, of UC and 35%, 17% and 35%, respectively, of CD patients diagnosed in 2015 had received IFX; in STK it was IFX for UC (8% of patients diagnosed in 2015) and adalimumab for CD (20% of patients diagnosed in 2015). Conclusion This retrospective observational study of >45 000 patients with inflammatory bowel disease in four Nordic countries showed reduced time between diagnosis and first biologic from 2010 to 2017, with the shortest time between diagnosis and first biologic in Norway. IFX was most commonly used.

scholarly journals P353 Pan-enteric capsule endoscopy enables assessment of mucosal healing after biologic treatment initiation in Crohn’s disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S373-S373
Author(s):  
A Volkers ◽  
P Bosuyt ◽  
J de Jong ◽  
G D’Haens ◽  
M Löwenberg
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Capsule Endoscopy ◽  
Effect Size ◽  
Treatment Initiation ◽  
Mucosal Healing ◽  
Biologic Treatment ◽  
Enteric Capsule ◽  
Before And After

Abstract Background Pan-enteric capsule endoscopy (pan-CE) visualizes the entire gastrointestinal tract and provides an attractive alternative to conventional ileocolonoscopy to evaluate luminal disease activity in Crohn’s disease (CD). An earlier study showed that pan-CE is feasible, safe and well tolerated by CD patients. The aim of the present study was to assess the Sensitivity TO measure Change (STOC) in mucosal disease activity using pan-CE in CD. Methods Patients with CD and active disease based on symptoms (i.e. Crohn’s disease activity index (CDAI) >150) and inflammatory biomarkers (i.e. C-reactive protein (CRP) >5 mg/L and/or fecal calprotectin (fCal) levels >250 mg/kg) underwent pan-CE, using the second-generation Pillcam colon capsule, prior to and 8-12 weeks after treatment initiation with infliximab, adalimumab or vedolizumab. Luminal disease activity was assessed using the Crohn’s disease endoscopic index of severity (CDEIS) and the simple endoscopic score for Crohn’s disease (SES-CD), expanded with two segments for the jejunum and pre-terminal ileum. Sensitivity to detect mucosal change was assumed if the standardized effect size was >0.8. Correlations between the evolution in CDAI, CRP and fCal with endoscopic activity scores before and after treatment initiation were calculated. Results Twenty-eight patients underwent pan-CE of whom two withdrew consent and four did not start biologic therapy. Twenty-two patients (78.6%) started biologic treatment and underwent pan-CE twice. Median duration between treatment initiation and pan-CE was 11 weeks (IQR: 9.8-12 weeks). Half of patients (11/22) were female and the median age was 24 years (IQR=22-38 years). The standardized effect size was 1.11 for CDEIS and 1.36 for SES-CD. Median CDEIS scores decreased from 6.8 (IQR=4.6-11.2) to 3 (IQR=0.9-6.0, p=0.01). Median SES-CD scores decreased from 15.5 (IQR=9.8-22.5) to 6 (IQR=2.8-11.3, p=0.001). SES-CD score per segment decreased significantly for colon segments, not for small bowel segments (figure 1). The difference in CDAI, CRP and fCal outcomes before and after treatment did not correlate with the change in CDEIS and SES-CD. Conclusion Pan-CE is useful to assess luminal disease activity in CD patients who embark on biological treatment. Pan-CE is sensitive to monitor mucosal healing outcomes and might therefore replace ileocolonoscopy for this indication in CD patients.

scholarly journals P274 Drug utilization of biologic therapy in Crohn’s disease and ulcerative colitis: A population based Danish cohort study 2015-2018

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S306-S307
Author(s):  
K Jensen ◽  
C B Jensen ◽  
C Wennerström ◽  
K J Sommer ◽  
J Burisch ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Drug Utilization ◽  
Biologic Therapy ◽  
Treatment Guidelines ◽  
Line Treatment ◽  
First Line ◽  
Biologic Treatment ◽  
First Line Treatment

Abstract Background For patients with Crohn’s disease (CD) and Ulcerative Colitis (UC) that are not adequately responding to systemic immunosuppressants, or are intolerant to conventional therapies, several biologic treatments have become available. The aim of the present study was to characterize the drug utilization and switch patterns of the biologics in respect to treatment line. Methods Using Danish national registries, the nation-wide study included individuals diagnosed with UC or CD who were biologic-naïve when initiating treatment with Infliximab (IFX), Adalimumab (ADA), Vedolizumab (VDZ), Golimumab (GOL), or Ustekinumab (UST) during years 2015-2018. The hazard ratios (HR) of switching or discontinuing from first treatment were explored using Cox regression adjusted for health-related and socio-economic parameters at treatment initiation. A therapy switch was defined as the administration of a biologic therapy different from the current within 90 days from last biologic dispensing period. Results Among 1,836 CD patients and 1,886 UC patients, IFX was used as first line biologic treatment in 91% (1,667) of CD patients and 92% (1,740) of UC patients. This was followed by ADA with 7% (129), VDZ with 2% (35) and UST with 0.2% (5) for CD patients, and ADA with 5% (88), VDZ with 2% (34) and GOL with 1% (24) for the UC patients, (figure 1). In total, 18% (338) of CD patients and 24% (451) of UC patients switched biologic during the study period. Among CD patients with IFX as first-line treatment, 12% (207/1667) switched to ADA, whereas 6% (96/1667) switched to VDZ. UC patients with IFX as first-line treatment, 6% (105/1740) switched to ADA, and 12% (201/1740) to VDZ. When administered ADA as first-line treatment, 11% (14/129) shifted to IFX in the CD patients, and 17% (15/88) shifted to IFX in the UC patients. Overall, 6% (111) of CD patients and 9% (163) of UC patients experienced ≥2 therapy switches during the study period. Comparing ADA to IFX as first-line treatment, there was a higher risk of discontinuation of treatment among CD patients (HR: 2.25 (95% confidence interval: 1.71; 2.97)) and in UC patients (1.93 (1.42; 2.63)), whereas no difference in risk of switch to another biologic treatment was observed. In both CD and UC patients, analyses of VDZ, GOL, and UST as first-line were impaired due to few events. Conclusion More than 90% of CD and UC patients initiating biologic therapy had IFX as their first-line biologic treatment, which is recommended by the official treatment guidelines. The reason for deviation from treatment guidelines or switch in therapy should be explored in further studies as well as the higher incidence of treatment discontinuation for ADA as first-line treatment.

P014 AVERAGE ANNUAL HEALTHCARE COSTS FOR PEDIATRIC AND ADULT PATIENTS WITH CROHN’S DISEASE OR ULCERATIVE COLITIS

2018 ◽  
Vol 24 (suppl_1) ◽  
pp. S6-S6
Author(s):  
Robert N Baldassano ◽  
Ahva Shahabi ◽  
Seth A Seabury ◽  
Darius Lakdawalla ◽  
Oliver Diaz ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Healthcare Costs ◽  
Adult Patients

scholarly journals DOP78 Intestinal surgery rates in ulcerative colitis and Crohn’s disease in the era of biologics: A Danish Nationwide Register Study from 2003 to 2016

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S116-S117
Author(s):  
K Vadstrup ◽  
S Alulis ◽  
A Borsi ◽  
J Olsen ◽  
T R Jørgensen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Resection ◽  
Register Study ◽  
Intestinal Surgery ◽  
Biologic Treatment ◽  
Number Of Patients ◽  
Surgery Rates ◽  
Nationwide Register Study

Abstract Background Biologic response modifiers (biologics) has been introduced as potent drugs for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC). Whether this has resulted in a reduction in the need for surgical treatment is controversial. This study aims to explore the surgery rates of patients diagnosed with CD and UC between 2003 and 2015 and correlate to those treated with biologics or not in Denmark with a follow-up until 2016. Methods This national register study included patients diagnosed between 2003 and 2015 and followed up until 2016, identified in the Danish National Patient Registry (NPR). Biologic therapies available in (parts of) the study period were infliximab, adalimumab, vedolizumab and golimumab. Surgery rates were identified through three types: bowel resections (code KJFB), total colectomies (code KJFH) and resections and excisions of the rectum (code KJGB). The share of patients undergoing surgery or initiating and receiving biologic treatment in each year was analysed. Additionally, patients undergoing surgery were stratified to receiving biological treatment in a period before the surgery or not and the time to first surgery was investigated. Results Among 10,302 CD patients and 22,144 UC patients, 2,328 CD patients and 2,128 UC patients underwent intestinal resection. Numbers were driven by the two first surgery codes (97% for CD and 93% for UC), and >1 resection was observed in 20% of the CD cases and more in the UC cases (40%), as expected due to reoperations. In the same period, 2,939 and 2,504 patients were treated with biologics for CD and UC, respectively, with an increase observed over the years. The vast majority were treated with an anti-TNF-α biologic, as vedolizumab was not approved in Denmark before 2015. We observed similar surgery rates of patients receiving biologics compared with those not treated with biologics. However, the time period from diagnosis to first intestinal surgery was observed to be longer for the patients treated with biologics (Figure1). Conclusion The number of patients undergoing intestinal resections or initiating biologic treatments after diagnosis increased throughout the study period for the full population. The risk of intestinal resections was similar in the group of patients who received biologicals compared with the group who did not, but the treatment seemed to postpone surgery in both diseases.

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