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The Impact of Intestinal Complications on Health Care Costs Among Patients With Inflammatory Bowel Disease Treated With Anti-Tumor Necrosis Factor Therapies.

Authors
  • Rubin, David T1
  • Griffith, Jenny2
  • Zhang, Qisu3
  • Hepp, Zsolt2
  • Keshishian, Allison3, 4
  • 1 University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA.
  • 2 AbbVie, North Chicago, Illinois, USA.
  • 3 STATinMED Research, Ann Arbor, Michigan, USA.
  • 4 New York City College of Technology, City University of New York, New York, New York, USA.
Type
Published Article
Journal
Inflammatory Bowel Diseases
Publisher
Oxford University Press
Publication Date
Jul 27, 2021
Volume
27
Issue
8
Pages
1201–1209
Identifiers
DOI: 10.1093/ibd/izaa270
PMID: 33107564
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Although there is evidence that anti-tumor necrosis factor (TNF) utilization earlier in the inflammatory bowel disease (IBD) course and before the onset of disease-related complications leads to improved patient outcomes, the health care costs and utilization impact have not been well defined. This study assessed differences in health care utilization and costs among patients with IBD treated with anti-TNFs. Patients with a diagnosis of ulcerative colitis (UC) or Crohn disease (CD) between January 1, 2001, and December 31, 2014, were identified from a claims database. Patients were required to have ≥1 claim for a 5-aminosalicylic acid, corticosteroid, or immunomodulator after the IBD diagnosis and ≥1 anti-TNF drug claim after the first IBD treatment. Complication and noncomplication cohorts were identified based on disease-related complications and IBD-related hospitalizations or emergency department visits for 6 months before anti-TNF initiation. Generalized linear models were used to compare health care costs and utilization for the 12 months after anti-TNF initiation (follow-up). The study included 6329 patients with CD and 4451 patients with UC. In patients with CD with complications, >33.7% had intestinal strictures and 6% had enteroenteric fistula before anti-TNF treatment. Patients with CD with complications incurred significantly higher IBD-related and all-cause health care costs during follow-up, and patients with UC experienced the same trends. These results suggest that anti-TNF treatment after, rather than before, a patient develops complications leads to a higher economic burden. However, these findings could also result from patients with more severe disease having early complications that are more difficult to treat. © 2020 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected]

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