Introduction Biologics are a ‘high-cost’ aspect of care for patients with IBD, with commissioners keen to streamline wherever possible. This has led to patchy availability across the UK, despite NICE approval. These drugs represent only a proportion of the cost of IBD care, however, and the majority of patients may benefit more from service improvement. In partnership with local CCGs, we sought to describe the entirety of the IBD patient pathway to facilitate discussions on cost-effectiveness while commissioning specific aspects of care.
Method The SEL IBD pathway was developed with the Area Prescribing Committee in partnership with expert patients, IBD physicians, nurse specialists and Pharmacists across six Acute Trusts. This involved: commissioning for disease monitoring; drug optimisation; funding of nursing and support staff; cost predictions to plan for expected prescribing costs. Operational data was collected at one Trust (KCH) as an exemplar. Key performance indicators were agreed with CCG leads and reported back at the end of year 1. All activity from March 2015 onward was regarded as occurring as a direct result of the implementation of the pathway. It was estimated that, despite ‘unfettered’ prescribing, the cost saving per Acute Trust would be £250k in year 1.
Results A telephone helpline led to the prevention of 198 ED attendances in year 1 as well as the subsequent hospital admission, thus a total cost avoidance of =£188k in year 1. Median hospital length of stay fell from 7.4 to 4.0 days (p=0.11). Nurse led appointments increased and median referral-to-diagnosis was 5.8 weeks (2-8). Introduction of biosimilars occurred in Q3 of the pathway (not included in cost projections), generating a gain share agreement to support ongoing service provision. Inappropriate steroid use fell from 22% to 9% (p<0.001)1. Vedolizumab increased, but biologic prescribing overall fell in year 1 due to drug cessation. The introduction of biosimilars further reduced prescribing costs. Total avoided drug expenditure exceeded £1m in year 1. In year 2, fewer patients underwent planned cessation and as expected, and the use of biosimilar infliximab ‘balanced’ costs.
Conclusion The introduction of a fully commissioned IBD pathway is associated with prevention of inappropriate ED attendance and hospital admission as well as reduced length of stay. Despite the introduction, and ‘unfettered prescribing’ of, novel agents with more patients treated overall drug expenditure was, at worst, neutral over two years. This model has been used as a template for several similar projects across the UK and it is hoped will improve the standard of care for patients with IBD.
. Hayee B, et al. UEG Journal2016;4(S5):A635.
Disclosure of Interest B Hayee Conflict with: Takeda, AbbVie, Allergan, Olympus, Conflict with: MSD, Takeda, AbbVie, Allergan, C Cheng: None Declared, S Mashari: None Declared, P Dubois: None Declared, D Sennik: None Declared, P Irving: None Declared, V Burgess: None Declared
- Inflammatory Bowel Disease