Wan George J, Kozma Chris M, Slaton Terra L, Olson William H, Feagan Brian G
Janssen Global Services , Beerse , Belgium.
J Med Econ. 2014 Jun;17(6):384-93. doi: 10.3111/13696998.2014.909436. Epub 2014 Apr 16.
Healthcare costs of inflammatory bowel disease are substantial. This study examined the effect of adherence versus non-adherence on healthcare costs in patients with inflammatory bowel disease.
Adults who started infliximab treatment between 2006 and 2009 and had a diagnosis of inflammatory bowel disease were identified from MarketScan Databases. Medication adherence was defined as an infliximab medication possession ratio of 80% or greater in the first year. Mean treatment effects (adherence versus non-adherence) on costs in adherent patients were estimated with propensity-weighted generalized linear models.
A total of 1646 patients were identified. Significant variables in the model used to develop propensity weights were age, year of infliximab initiation, having Medicare coverage, presence of supplementary diagnoses, office as the place of service for infliximab initiation, prior aminosalicylate use, prior outpatient costs, number of prior outpatient visits, and number of prior colonoscopies. Mean total costs in adherent (n = 674) and propensity-weighted non-adherent (n = 972) patients were $41,713 versus $47,411 overall (p < 0.001), including $28,289 versus $14,889 for infliximab drug costs (p < 0.001), $2458 versus $17,634 for hospitalizations (p < 0.001), $7357 versus $10,909 for outpatient visits (p < 0.001), $236 versus $458 for emergency room visits (p < 0.001), and $3373 versus $3521 for other pharmaceuticals costs (p = 0.460).
Costs associated with infliximab administration (infusions, adverse events) were captured in healthcare costs (inpatient, outpatient, and emergency room), not in infliximab costs. The influence of adherence on indirect costs (e.g., time lost from work) could not be determined. Reasons for non-adherence were not available in the database.
In patients who were adherent to infliximab treatment (a medication possession ratio of 80% or greater in the first year), adherence versus non-adherence was associated with lower total healthcare costs, supporting the overall value of infliximab adherence in patients with inflammatory bowel disease.
炎症性肠病的医疗费用高昂。本研究探讨了炎症性肠病患者坚持用药与不坚持用药对医疗费用的影响。
从MarketScan数据库中识别出2006年至2009年间开始使用英夫利昔单抗治疗且诊断为炎症性肠病的成年人。药物依从性定义为第一年英夫利昔单抗的药物持有率达到80%或更高。使用倾向加权广义线性模型估计坚持用药的患者中坚持用药与不坚持用药对费用的平均治疗效果。
共识别出1646例患者。用于建立倾向权重的模型中的显著变量包括年龄、英夫利昔单抗开始使用年份、拥有医疗保险、存在补充诊断、英夫利昔单抗开始使用的服务地点为诊所、既往使用氨基水杨酸类药物、既往门诊费用、既往门诊就诊次数以及既往结肠镜检查次数。坚持用药的患者（n = 674）和倾向加权后不坚持用药的患者（n = 972）的平均总费用总体上分别为41,713美元和47,411美元（p < 0.001），其中英夫利昔单抗药物费用分别为28,289美元和14,889美元（p < 0.001），住院费用分别为2458美元和17,634美元（p < 0.001），门诊就诊费用分别为7357美元和10,909美元（p < 0.001），急诊就诊费用分别为236美元和458美元（p < 0.001），其他药品费用分别为3373美元和3521美元（p = 0.460）。
与英夫利昔单抗给药相关的费用（输液、不良事件）计入了医疗费用（住院、门诊和急诊），而非英夫利昔单抗费用中。无法确定依从性对间接费用（如工作时间损失）的影响。数据库中没有不坚持用药的原因。
在坚持英夫利昔单抗治疗的患者（第一年药物持有率达到80%或更高）中，坚持用药与不坚持用药相比，总医疗费用较低，这支持了英夫利昔单抗依从性在炎症性肠病患者中的总体价值。
