Crohn's costs in 'era of biologics' higher than expected
A longitudinal retrospective cohort analysis showed total health care costs for Crohn’s disease are higher than previous estimates, with the majority of total costs allocated to a minority of patients.
“Our study shows that today’s IBD care costs more than we anticipated or previously estimated, in a large part due to increasing use of pharmaceuticals — especially biologic therapies,” K. T. Park, MD, MS, assistant professor of pediatric gastroenterology and co-director of the Stanford Children's IBD Center at Stanford University in Palo Alto, told Healio Gastroenterology. “The ‘era of biologics’ is an appropriate description since these drugs have changed how we manage IBD and are far and away the most effective yet most expensive medical therapy option in our arsenal — and more are on the horizon, including the separate category of biosimilars. When these drugs are used well in an evidence-based way, they can quickly reverse active disease, improve patients’ quality of life, and possibly even modify their future outcomes.”
K. T. Park
Park and colleagues used claims data from 11 U.S. health insurance plans to ascertain the mean annual health plan-paid cost per patient with Crohn’s disease between 2011 and 2013. They also sought to assess the cost contribution of anti-tumor necrosis factor (TNF) agents, and to evaluate if patient demographics and 31 Crohn’s-specific comorbidities correlated with health-plan paid costs.
They identified a total of 5,090 Crohn’s patients (mean age, 41.6 years; 57% female). The mean health-plan paid cost per member per year was $18,637 ± $32,023, which correlated with the number of comorbidities (P < .0001). Overall, 28% of patients incurred 80% of the total costs.
When analysis was restricted to patients aged 20 years or younger (n = 587; mean age, 15.8 ± 3.42 years; 53% male), the mean health-plan paid cost per member per year was $22,796 ± $41,905, which correlated with the number of comorbidities (P < .0001) and age (P < .05).
When analysis was restricted to patients aged older than 20 years (n = 4,503; mean age, 45 ± 13.79 years; 58% female), the mean health-plan paid cost per member per year was $18,095 ± $30,065, which correlated with the number of comorbidities (P < .0001) and age (P < .05). No differences based on gender were observed in any group.
Mean health care costs were $4,701 higher for patients aged 20 years or younger compared with those aged older than 20 years (P < .05). Post-hoc analysis using 2,756 matched controls without Crohn’s disease showed Crohn’s patients had about 3.5-fold higher health care costs.
Cost-driver analysis showed pharmacy utilization accounted for 45.5% of total costs paid (29.8% anti-TNF agents alone), while inpatient costs accounted for 23.1%, outpatient hospital costs accounted for 15.7% and MD office costs accounted for 8.2%.
“The take-home point for my practice has been two-fold,” Park said. “First, it’s even more important to be up to date on the consensus guidelines for biologics use in IBD. We need to practice evidence-based, cost-effective medicine, especially since these drugs cost so much. Secondly, we need to keep thinking about how to improve IBD care at the individual patient level. Each patient is different. Since a minority of IBD patients account for the majority of health care costs, we should keep asking ourselves at every visit, ‘How can we streamline or optimize this individual patient’s care?’” – by Adam Leitenberger
Disclosure: Park reports he is a medical advisory board member for Accordant Health Services. Please see the full study for a list of all other authors’ relevant financial disclosures.