Abstract
Background: Anti-tumor necrosis factor (anti-TNF) drugs are highly effective in the treatment of moderate-to-severe Crohn's disease (CD) and ulcerative colitis (UC), but they are very costly. Due to their effectiveness, they could potentially reduce future health care spending on other medical therapies, hospitalization, and surgery. The impact of downstream costs has not previously been quantified in a real-world population-based setting. Methods: We used the University of Manitoba IBD Database to identify all persons in a Canadian province with CD or UC who received anti-TNF therapy between 2004 and 2016. All inpatient, outpatient, and drug costs were enumerated both in the year before anti-TNF initiation and for up to 5 years after anti-TNF initiation. Costs before and after anti-TNF initiation were compared, and multivariate linear regression analyses were performed to look for predictors of higher costs after anti-TNF initiation. Results: A total of 928 people with IBD (676 CD, 252 UC) were included for analyses. The median cost of health care in the year before anti-TNF therapy was $4698 for CD vs $6364 for UC. The median cost rose to $39,749 and $49,327, respectively, in the year after anti-TNF initiation, and to $210,956 and $245,260 in the 5 years after initiation for continuous anti-TNF users. Inpatient and outpatient costs decreased in the year after anti-TNF initiation by 12% and 7%, respectively, when excluding the cost of anti-TNFs. Conclusions: Direct health care expenditures markedly increase after anti-TNF initiation and continue to stay elevated over pre-initiation costs for up to 5 years, with only small reductions in the direct costs of non-drug-related health care.
| Original language | English |
|---|---|
| Pages (from-to) | 1718-1728 |
| Number of pages | 11 |
| Journal | Inflammatory Bowel Diseases |
| Volume | 25 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 1 2019 |
Bibliographical note
Funding Information:From the *Section of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada; †Children’s Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada; ‡Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; §Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; ¶Department of Economics, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada; ‖Department of Community Health Sciences, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada; **Arthritis Research Centre, University of British Columbia, Vancouver, BC, Canada; ††Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada; ‡‡Department of internal Medicine, Dalhousie University, Halifax, NS, Canada; §§The Ottawa Hospital IBD Centre, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada; ¶¶Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Ontario; ‖‖Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Ontario; and ***Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada Disclaimer: The funders were not involved in the design of the protocol, analysis of the data, or writing of the manuscript and had no editorial influence on the manuscript. Conflicts of interests: Laura Targownik has received investigator-initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Takeda Canada, Merck Canada, Pfizer Canada, and Mallinckrodt USA. Charles Bernstein
Funding Information:
has served on advisory boards for AbbVie Canada, Ferring Canada, Janssen Canada, Shire Canada, Takeda Canada, and Pfizer Canada; has served as a consultant for Mylan Pharmaceuticals; has received educational grants from Abbvie Canada, Shire Canada, Takeda Canada, and Janssen Canada; has served on speakers’ panels for Abbvie Canada, Ferring Canada, and Shire Canada; and has received research funding from Abbvie Canada. Harminder Singh has been on advisory boards for Pendopharm, Ferring, and Merck Canada and has received research funding from Merck Canada. Jennifer Jones has been on advisory boards, acted as a consultant, and been a speaker for Janssen and Abbvie. Gil Kaplan has received speaking or consultancy honoraria from AbbVie, Janssen, Pfizer, and Shire and has received grants from Abbvie, Janssen, Merck, and Shire. Sanjay Murthy has served on advisory boards for Abbvie, Ferring, Shire, Takeda, and Pfizer. All other authors have nothing to declare.
Funding Information:
Supported by: an unrestricted grant from Crohn’s and Colitis Canada and the Helmsley Foundation. Author contributions: Study concept and design: L.T., J.W., E.B., C.B., G.K. Acquisition of data: L.T., J.W. Analysis and interpretation of data: L.T., J.W., E.B., C.B., G.K., L.L. Drafting of the manuscript: L.T., J.W. Critical revision of the manuscript for important intellectual content: L.T., E.B., C.B., H.S., L.L., A.A.Z., S.C., J.J., G.K., S.M., G.N., J.N.P.S. Statistical analysis: L.T., J.W., S.C., L.L., A.T., S.L. Obtained funding: L.T.
Publisher Copyright:
© 2019 Crohn's & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ASJC Scopus Subject Areas
- Immunology and Allergy
- Gastroenterology
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't