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Resources Utilization and Costs the Year Before and After Starting Treatment with Adalimumab in Crohn's Disease
Cristina Saro1, Daniel Ceballos, Fernando Muñoz
1*Gastroenterology Service, Hospital de Cabueñes, Gijón, Spain; †Gastroenterology Service, Hospital Dr. Negrín, Las Palmas, Spain; ‡Gastroenterology Service, Complejo Asistencial Universitario de León, León, Spain; §Research Department, Advanced Techniques for Health Services Research, Madrid, Spain; ‖Digestive System Service, Hospital Universitario Reina Sofía, Córdoba, Spain; ¶Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain; **Gastroenterology Service, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; ††Gastroenterology Service, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain; ‡‡Gastroenterology Service, Hospital Universitario Río Hortega, Valladolid, Spain; §§Gastroenterology Department, University Central Hospital of Asturias, Oviedo, Spain; and ‖‖Gastroenterology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Insights
Adalimumab treatment for Crohn's disease (CD) improves remission rates and reduces healthcare resource utilization, despite increased drug costs. The drug's efficiency is notably higher in patients with severe disease (CDAI > 150).
Area of Science:
- Gastroenterology
- Health Economics
- Pharmacoeconomics
Background:
- Crohn's disease (CD) management involves significant healthcare resource utilization and costs.
- Evaluating the economic impact and efficiency of biologic therapies like adalimumab is crucial for patient care and resource allocation.
Purpose of the Study:
- To assess resource utilization and the efficiency of adalimumab in Crohn's disease patients.
- To compare healthcare costs and outcomes in the year before and after initiating adalimumab treatment.
Main Methods:
- An observational, multicenter, prospective cohort study involving 126 biologic-naive CD patients.
- Effectiveness was measured by the proportion of patients achieving a Crohn's Disease Activity Index (CDAI) <150.
- Direct (DC) and indirect costs (IC) were analyzed, with efficiency estimated via incremental cost/effectiveness ratio (ICER).
Main Results:
- Remission rates increased from 34.1% to 83.3% post-adalimumab initiation.
- Despite increased adalimumab costs, utilization of other healthcare resources (visits, tests, non-biologic drugs) decreased (P < 0.05).
- Base case ICER was €31,308 (DC) and €28,936 (DC+IC); for CDAI > 150 patients, ICER was €20,119 (DC) and €18,223 (DC+IC).
Conclusions:
- Adalimumab increases drug costs but reduces overall healthcare resource use and indirect costs in CD patients.
- The efficiency of adalimumab is significantly higher (30%) in patients with higher baseline disease activity (CDAI > 150).
- Adalimumab offers a favorable cost-effectiveness profile, particularly for patients with more severe Crohn's disease.
Background:
This study examines the resources utilization in patients with Crohn's disease (CD) during the year before (Y - 1) and after (Y + 1) starting treatment with adalimumab and the drug's efficiency.
Methods:
Observational, multicenter, prospective cohort study of patients with CD naive to biological drugs. The proportion of patients with CD Activity Index (CDAI) <150 was considered as the effectiveness variable. Costs considered were direct costs (DC) related to the use of health care resources, and indirect costs (IC) related to sick leave in Y - 1 and Y + 1. Adalimumab efficiency was estimated as the incremental cost/effectiveness ratio. A deterministic sensitivity analysis was performed building 3 scenarios: base case, the least favorable, and the most favorable case for adalimumab.
Results:
In the cohort of 126 patients (50.8% men; age 39.1 ± 13.8 yr), the proportion of patients in remission increased from 34.1% by the end of Y - 1 to 83.3% by the end of Y + 1. Although the DC increase by the use of adalimumab, the use of doctor visits, emergency room visits, laboratory tests, diagnostic examinations, and nonbiological drug treatment were lower (P < 0.05) in Y + 1 than Y - 1. In the base case scenario, considering only DC, the incremental cost/effectiveness ratio was €31,308 and including IC, it was €28,936. In patients with CDAI > 150 at the onset, incremental cost/effectiveness ratio was €20,119 and €18,223, considering DC alone or included IC, respectively.
Conclusions:
In patients with CD, adalimumab increases pharmacological costs at the expense of biological therapy but reduces the cost of other drugs, the use of health care resources, and IC. Adalimumab efficiency is 30% greater in patients with CDAI > 150.
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