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Infliximab decreases resource use among patients with Crohn's disease
Joel H Rubenstein1, Rachel Y Chong, Russell D Cohen
1University of Chicago Hospitals, Chicago, Illinois 60637, U.S.A.
Insights
Infliximab treatment for Crohn's disease (CD) significantly reduced hospitalizations and surgeries, particularly in patients with fistulas. This suggests potential overall healthcare cost savings for CD patients using this therapy.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Health Economics
Background:
- Crohn's disease (CD) management incurs substantial costs, with surgery and hospitalizations accounting for a significant portion.
- Infliximab is an effective treatment for CD, inducing remission and healing fistulas, but its impact on healthcare resource utilization remains unclear.
Purpose of the Study:
- To evaluate the effect of infliximab on healthcare resource utilization in patients with Crohn's disease.
- To assess changes in hospitalizations, surgeries, and outpatient visits before and after infliximab initiation.
Main Methods:
- Retrospective review of medical records for Crohn's disease patients managed for at least one year pre- and post-infliximab infusion.
- Analysis of incidences of hospitalizations, surgeries, endoscopies, radiologic examinations, and outpatient/emergency room visits.
Main Results:
- Overall reduction in annual surgeries (38%) and emergency room visits (66%) post-infliximab.
- Fistula patients experienced significant decreases in hospitalizations (59%) and surgeries (66%).
- Luminal disease patients showed reduced endoscopies (52%) and ER visits (69%).
Conclusions:
- Infliximab therapy is associated with decreased healthcare resource utilization in Crohn's disease patients.
- The reduction in hospitalizations and surgeries, especially in fistula patients, indicates potential for overall cost savings.
- These findings support the cost-effectiveness of infliximab in managing Crohn's disease.
Goals:
Surgery accounts for one half, and hospitalizations for one third, of overall costs for patients with Crohn's disease (CD). Infliximab induces remission and heals fistulas in CD but is more costly than traditional therapies. Its impact upon resource use in CD is unknown.
Study:
The medical records were reviewed for all CD patients managed at our institution for at least 1 full year both before and after initial infliximab infusion. The incidences of hospitalizations, hospitalized days, surgeries, endoscopies, radiologic examinations, outpatient and emergency room (ER) visits were studied (weighted according to time period).
Results:
There were 79 patients (59% female, mean age 38.6 years). A decrease was seen in the annual incidence of all surgeries (38%, p < 0.01), gastrointestinal (GI) surgeries (18%, p < 0.05), endoscopies (43%, p < 0.01), ER visits (66%, p < 0.05), all outpatient visits (16%, p < 0.05), outpatient GI visits (20%, p < 0.01), all radiologic examinations (12%, p < 0.01), and non-plain films (13%, p < 0.01). Fistula patients (n = 37) had decreases in hospitalizations (59%, p < 0.05); GI surgeries (59%, p < 0.01); all surgeries (66%, p < 0.01); all, GI, and surgical outpatient visits (27%, 26%, and 70%, respectively, p < 0.05 for all); ER visits (64%, p < 0.05); all radiologic examinations (40%, p < 0.05); and non-plain films (61%, p < 0.05). Patients with luminal disease(n = 42) had decreases in endoscopies (52%, p < 0.05), and ER visits (69%, p < 0.05). Patients of both genders and all ages experienced decreases in resource use.
Conclusion:
Patients with CD decreased their use of some services, with a decreased number of hospitalizations and a decrease in the use of surgical services seen primarily in the patients infused for fistulas. This decrease in use of healthcare resources raises the potential of overall cost savings in CD patients receiving this drug.