Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, Stanford, California, USA.
Am J Gastroenterol. 2020 Oct;115(10):1698-1706. doi: 10.14309/ajg.0000000000000750.
Biologic agents including infliximab are effective but costly therapies in the management of inflammatory bowel disease (IBD). Home infliximab infusions are increasingly payer-mandated to minimize infusion-related costs. This study aimed to compare biologic medication use, health outcomes, and overall cost of care for adult and pediatric patients with IBD receiving home vs office- vs hospital-based infliximab infusions.
Longitudinal patient data were obtained from the Optum Clinformatics Data Mart. The analysis considered all patients with IBD who received infliximab from 2003 to 2016. Primary outcomes included nonadherence (≥2 infliximab infusions over 10 weeks apart in 1 year) and discontinuation of infliximab. Secondary outcomes included outpatient corticosteroid use, follow-up visits, emergency room visits, hospitalizations, surgeries, and cost outcomes (out-of-pocket costs and annual overall cost of care).
There were 27,396 patients with IBD (1,839 pediatric patients). Overall, 5.7% of patients used home infliximab infusions. These patients were more likely to be nonadherent compared with both office-based (22.2% vs 19.8%; P = .044) and hospital-based infusions (22.2% vs 21.2%; P < .001). They were also more likely to discontinue infliximab compared with office-based (44.7% vs 33.7%; P < .001) or hospital-based (44.7% vs 33.4%; P < .001) infusions. On Kaplan-Meier analysis, the probabilities of remaining on infliximab by day 200 of therapy were 64.4%, 74.2%, and 79.3% for home-, hospital-, and office-based infusions, respectively (P < .001). Home infliximab patients had the highest corticosteroid use (cumulative corticosteroid days after IBD diagnosis: home based, 238.2; office based, 189.7; and hospital based, 208.5; P < .001) and the fewest follow-up visits. Home infusions did not decrease overall annual care costs compared with office infusions ($49,149 vs $43,466, P < .001).
In this analysis, home infliximab infusions for patients with IBD were associated with suboptimal outcomes including higher rates of nonadherence and discontinuation of infliximab. Home infusions did not result in significant cost savings compared with office infusions.
英夫利昔单抗等生物制剂是治疗炎症性肠病（IBD）的有效但昂贵的疗法。家庭英夫利昔单抗输注越来越多地受到付款人的要求，以最大限度地降低输注相关成本。本研究旨在比较接受家庭、办公室和医院为基础的英夫利昔单抗输注的成人和儿科 IBD 患者的生物药物使用、健康结果和总体护理成本。
从 Optum Clinformatics Data Mart 获得纵向患者数据。该分析考虑了所有 2003 年至 2016 年期间接受英夫利昔单抗治疗的 IBD 患者。主要结局包括不遵医嘱（1 年内 10 周内间隔≥2 次英夫利昔单抗输注）和停止使用英夫利昔单抗。次要结局包括门诊皮质类固醇使用、随访就诊、急诊就诊、住院、手术和成本结果（自付费用和年度总护理成本）。
共有 27396 名 IBD 患者（1839 名儿科患者）。总体而言，5.7%的患者使用家庭英夫利昔单抗输注。与办公室为基础的输注（22.2%比 19.8%；P=.044）和医院为基础的输注（22.2%比 21.2%；P<.001）相比，这些患者更有可能不遵医嘱。与办公室为基础的输注（44.7%比 33.7%；P<.001）或医院为基础的输注（44.7%比 33.4%；P<.001）相比，他们也更有可能停止使用英夫利昔单抗。在 Kaplan-Meier 分析中，接受家庭、医院和办公室为基础的输注的患者在治疗第 200 天保持英夫利昔单抗治疗的概率分别为 64.4%、74.2%和 79.3%（P<.001）。家庭英夫利昔单抗患者的皮质类固醇使用量最高（IBD 诊断后累积皮质类固醇天数：家庭为基础，238.2；办公室为基础，189.7；和医院为基础，208.5；P<.001），随访就诊次数最少。与办公室输注相比，家庭输注并未降低总体年度护理成本（$49149 比$43466，P<.001）。
在本分析中，IBD 患者的家庭英夫利昔单抗输注与不理想的结局相关，包括不遵医嘱和停止使用英夫利昔单抗的比率较高。与办公室输注相比，家庭输注并未导致显著的成本节约。
