Janssen Services, LLC, Horsham, PA 19044, USA.
Adv Ther. 2011 Aug;28(8):671-83. doi: 10.1007/s12325-011-0048-7. Epub 2011 Aug 3.
Few published reports have described the impact of adherence with biologic agents on hospitalizations and inpatient costs in Crohn's disease (CD).
A retrospective claims analysis using the IMS LifeLink Health Plan Claims Database between September 1, 2004 and June 30, 2009 was conducted. Continuous enrollment for 12 months before and 12 months after the index date was required. Patients were required to have ≥2 claims with an International Classification of Diseases, 9th Edition, Clinical Modification diagnosis code for CD (555.xx) preindex, be ≥18 years of age at index, and have ≥4 infliximab infusions with a gap no greater than 12 weeks between each infusion. Patients with 7-9 infliximab infusions (12 months postindex) were considered adherent; patients with 4-6 infliximab infusions were considered nonadherent.
In total, 638 patients were included in the analyses (mean age, 43 years; 58% female in the adherent group and 53% in the nonadherent group). The number of patients who met the definition of adherence was 466 (73%). A smaller proportion of adherent patients had a CD-related emergency room visit, compared with nonadherent patients (11% vs. 17%, P=0.029). A smaller proportion of adherent patients required CD-related hospitalization, compared with nonadherent patients (8% vs. 12%, P=0.117). Among those hospitalized, adherent patients had fewer mean [median] days in the hospital (5.9 [5] days), compared with nonadherent patients (12.8 [8] days, P=0.015). Mean [median] hospital costs were significantly lower for adherent patients ($13,427 [$9,352]), compared with nonadherent patients ($37,783 [$28,864], P=0.001). Multivariate analyses confirmed lower inpatient (P<0.001) costs for adherent versus nonadherent patients.
Adherence with infliximab therapy during the first year of treatment in patients with CD was associated with a shorter hospital length of stay and lower inpatient costs compared with nonadherent patients. Strategies for increasing adherence rates to infliximab maintenance therapy may be valuable in reducing hospitalizations and inpatient costs in patients with CD.
鲜有文献报道生物制剂的使用依从性对克罗恩病（CD）患者的住院情况和住院费用的影响。
本研究采用 IMS LifeLink 健康计划理赔数据库，对 2004 年 9 月 1 日至 2009 年 6 月 30 日期间的数据进行回顾性理赔分析。要求患者在索引日期前的 12 个月和后 12 个月内连续入组，并在入组前至少有两次 ICD-9-CM 诊断代码为 CD（555.xx）的索赔记录，且患者年龄≥18 岁，在索引日期后至少接受 4 次英夫利昔单抗输注，且两次输注之间的间隔时间不超过 12 周。索引日期后接受 7-9 次英夫利昔单抗输注的患者被认为是依从性良好的患者，接受 4-6 次英夫利昔单抗输注的患者被认为是不依从性良好的患者。
共纳入 638 例患者（平均年龄 43 岁，依从性组和不依从性组中分别有 58%和 53%的患者为女性）。符合依从性定义的患者有 466 例（73%）。与不依从性患者相比，依从性患者发生 CD 相关急诊就诊的比例较小（11% vs. 17%，P=0.029）。与不依从性患者相比，依从性患者需要 CD 相关住院治疗的比例较小（8% vs. 12%，P=0.117）。在住院患者中，依从性患者的平均住院时间（5.9[5]天）和中位住院时间（5 天）均短于不依从性患者（12.8[8]天，P=0.015）。依从性患者的平均住院费用[中位数]显著低于不依从性患者（13427 美元[9352 美元] vs. 37783 美元[28864 美元]，P=0.001）。多变量分析证实，与不依从性患者相比，依从性患者的住院费用较低（P<0.001）。
与不依从性患者相比，CD 患者在接受英夫利昔单抗治疗的第一年中依从性较高，其住院时间较短，住院费用较低。提高英夫利昔单抗维持治疗依从性的策略可能有助于降低 CD 患者的住院率和住院费用。
