Introduction Anti-tumour necrosis factor (anti-TNF) medications have never been compared in a direct fashion under real-world circumstances. The purpose of this study was to compare healthcare utilisation and costs using insurance data for patients with Crohn's disease (CD) who newly initiated anti-TNF therapy with adalimumab (ADA) or infliximab (IFX).
Methods Patients with ≥2 diagnoses of CD (ICD-9-CM: 555.XX) who initiated ADA or IFX therapy between January 2000 and March 2009 were identified from the Medstat MarketScan database. Patients had to be continuously enrolled at least 6 months before and after anti-TNF initiation. Patients with prior biologic therapy (ie, anti-TNF or natalizumab) or colitis (ICD-9-CM: 556.x) were excluded. ADA and IFX groups were matched 1:1 using a propensity score stratified by age, residence, inpatient visit utilisation and steroid use at baseline. The primary endpoint was 6-month direct cost of healthcare. The secondary endpoints compared healthcare utilisation between groups.
Results After propensity matching, demographic, clinical and healthcare utilisation characteristics were similar between the ADA (n=623) and IFX (n=623) groups at baseline. During the 6-month interval following anti-TNF initiation, healthcare costs were significantly lower for ADA compared with IFX therapy (table 1).
|All-Cause, ADA (n=623)||All-Cause, IFX (n=623)||CD-Relateda, ADA (n=623)||CD-Relateda, IFX (n=623)|
|Anti-TNF drug costs||–||–||10 709||12 401|
|Other prescription drug costs||1334b||1639||546||857|
|Total medical service–related costs||6842b||10 316||5199b||9059|
|Total healthcare costs (costs excluding anti-TNF agents)||18 885b (8176b)||24 355 (11 955)||16 454b (5745b)||22 316 (9916)|
Both all-cause and CD-related hospitalisation decreased for both ADA and IFX groups (not shown). Emergency department (ED) use and hospitalisation in the 6-month follow-up period were similar between groups.
Conclusion In this real-world analysis of patients with CD who newly initiated with ADA or IFX, ADA-treated patients had significantly lower healthcare costs. Hospitalisation and ED utilisation were similar between groups.
- Crohn's disease
- healthcare costs
- TNF-alpha inhibitors
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Competing interests D. Sussman: None Declared, N. Kubiliun: None Declared, J. Chao Shareholder with: Abbott, Employee of: Abbott, P. Mulani Shareholder with: Abbott, Employee of: Abbott, C. Gillis Shareholder with: Abbott, Employee of: Abbott, M. Yang Shareholder with: Abbott, Employee of: Abbott, M. Lu Employee of: Analysis Group; under contract with Abb., M. Abreu Consultant for: Abbott, Amgen, Elan, Opson, Prometheus, Salix, UCB