Biologics safer, more cost-effective than corticosteroids long term in IBD
ORLANDO, Fla. — Biologic medications, although initially costlier, were more cost-effective, safer and beneficial in the long term than oral corticosteroids for treating patients with inflammatory bowel disease, according to a poster presentation at Advances in IBD 2017.
Notably, investigators reported that patients with Crohn’s disease and ulcerative colitis who received chronic oral corticosteroids showed an increased risk for adverse events and required more health care resources.
To compare adverse events, health care resource utilization, and the drug and medical service costs of the four main classes of IBD therapies, Ashwin Ananthakrishnan, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues reviewed U.S. claims data on 30,676 patients with IBD from 2010 to 2015. The cohort included 14,528 patients with CD and 16,148 patients with UC, representing 34,952 treatment episodes.
Anti-tumor necrosis factor use was more prevalent among patients with CD, with about 40% receiving them, compared with patients with UC, with about 16% receiving them, investigators noted.
They found that oral corticosteroid monotherapy or combination therapy involving oral corticosteroids and immunosuppression were the strongest predictors of any adverse events, as well as bone-related conditions and severe hepatic events, in patients with CD and UC. For example, patients with CD who received oral corticosteroid monotherapy showed an OR of 1.62 (95% CI, 1.51-1.73) for any treatment-related adverse event.
However, both oral corticosteroid therapy and a regimen containing anti-TNF were the strongest predictors of severe infection in patients with CD and UC.
Regarding health care resource utilization, Ananthakrishnan and colleagues reported that patients who received corticosteroid-containing regimens were more likely to require ED visits, IBD-related hospitalizations, doctor visits or procedures vs. patients who received other therapies. Patients with CD, for instance, showed a threefold higher rate of gastrointestinal surgery and IBD-related procedures or events when they received corticosteroids rather than an anti-TNF, and similar trends were observed in patients with UC.
Finally, analysis of medical costs showed that total annual medical costs were highest for anti-TNF alone or in combination with immunosuppressants. For example, patients with UC who received anti-TNF monotherapy required more than $51,000 in annual health care costs compared with about $29,000 for those who received corticosteroid monotherapy. However, when excluding drug costs, annual medical service costs were highest for patients who received corticosteroids (about $27,000 with corticosteroid monotherapy vs. $13,000 for anti-TNF monotherapy in CD).
“These data suggest that limiting the use of [oral corticosteroid] regimens in favor of biologic treatments may be more costly initially but may have fewer [adverse events] and decreased medical service costs,” Ananthakrishnan and colleagues concluded. “Therapy decisions should consider the downstream benefits of alternate options because they are safer, provide better disease control and offer potentially more cost-effective long-term benefit.” – by Adam Leitenberger
Long GH, et al. Abstract P-002. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.
Disclosure: Ananthakrishnan reports he has financial relationships with AbbVie and Takeda.