Kochar Bharati, Jiang Yue, Chen Wenli, Bu Yuting, Barnes Edward L, Long Millie D
Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Statistical Science, Duke University, Durham, NC, USA.
Crohns Colitis 360. 2021 Sep 1;3(3):otab063. doi: 10.1093/crocol/otab063. eCollection 2021 Jul.
Home infusions (HIs) for biologic medications are an option for inflammatory bowel disease (IBD) patients in the United States. We aimed to describe the population receiving HIs and report patient experience with HIs.
We conducted a retrospective cohort study in the Quintiles-IMSLegacy PharMetrics Adjudicated Claims Database from 2010 to 2016 to describe the population receiving infliximab (IFX) and vedolizumab (VDZ) HIs and determine predictors for an urgent/emergent visit post-HIs. We then administered a cross-sectional survey to IBD Partners Internet-based cohort participants to assess knowledge and experience with infusions.
We identified claims for 11 892 conventional IFX patients, 1573 home IFX patients, 438 conventional VDZ patients, and 138 home VDZ patients. There were no differences in demographics or median charges with IFX home and conventional infusions. Home VDZ infusions had a greater median charge than conventional VDZ infusion. Less than 4% of patients had an urgent/emergent visit post-HIs. Charlson comorbidity index > 0 (odds ratio [OR]: 1.95; 95% confidence interval [CI], 1.01-3.77) and Medicaid (OR: 3.01; 95% CI, 1.53-5.94) conferred significantly higher odds of urgent/emergent visit post-HIs. In IBD Partners, 644 IBD patients responded; 56 received HIs. The majority chose HIs to save time and preferred HIs to conventional infusions. Only 2 patients reported an urgent/emergent visit for HI-related problems.
HI appears to be safe in IBD patients receiving IFX and VDZ. However, patients with fewer resources and more comorbidities are at increased risk for an urgent/emergent visit post-HIs. The overall patient experience with HI is positive. Expansion of HIs may result in decreased therapy-related logistic burden for carefully selected patients.
在美国，生物制剂的家庭输注（HI）是炎症性肠病（IBD）患者的一种选择。我们旨在描述接受HI治疗的人群，并报告患者对HI的体验。
我们在昆泰-IMS遗留PharMetrics判定索赔数据库中进行了一项回顾性队列研究，研究时间为2010年至2016年，以描述接受英夫利昔单抗（IFX）和维多珠单抗（VDZ）HI治疗的人群，并确定HI治疗后紧急就诊的预测因素。然后，我们对IBD Partners基于互联网的队列参与者进行了一项横断面调查，以评估输液的知识和体验。
我们确定了11892例传统IFX患者、1573例家庭IFX患者、438例传统VDZ患者和138例家庭VDZ患者的索赔记录。IFX家庭输注和传统输注在人口统计学或中位数费用方面没有差异。家庭VDZ输注的中位数费用高于传统VDZ输注。不到4%的患者在HI治疗后进行了紧急就诊。查尔森合并症指数>0（比值比[OR]：1.95；95%置信区间[CI]，1.01-3.77）和医疗补助（OR：3.01；95%CI，1.53-5.94）显著增加了HI治疗后紧急就诊的几率。在IBD Partners中，644例IBD患者做出了回应；56例接受了HI治疗。大多数人选择HI治疗是为了节省时间，并且比起传统输注更喜欢HI治疗。只有2例患者报告因HI相关问题进行了紧急就诊。
对于接受IFX和VDZ治疗的IBD患者，HI似乎是安全的。然而，资源较少且合并症较多的患者在HI治疗后紧急就诊的风险增加。患者对HI的总体体验是积极的。扩大HI治疗可能会降低精心挑选患者的治疗相关后勤负担。
