Mahlich Joerg, May Melanie, Feig Chiara, Straub Vincent, Schmelz Renate
Health Economics and Outcomes Research, Janssen-Cilag GmbH, Neuss, Germany.
Düsseldorf Institute for Competition Economics (DICE), DICE, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Crohns Colitis 360. 2021 Feb 23;3(2):otab011. doi: 10.1093/crocol/otab011. eCollection 2021 Apr.
In recent years, biologic agents became a relevant and promising treatment option for inflammatory bowel diseases (IBDs). However, high treatment costs and moderate remission rates lead to a high interest in treatment persistence and corresponding economic consequences.
A retrospective health claims data analysis was conducted including biologic naive patients diagnosed with IBD between 2013 and 2018. Observation points were at 12 and 18 months of follow-up, starting from the first biologic prescription. Nonpersistence was defined as either no further prescription or prescription of another biologic agent within the days of supply per original prescription. Biologic agents included were Adalimumab, Golimumab, Infliximab, Ustekinumab, and Vedolizumab.
In total, 1444 patients with IBD were included in this analysis, mostly treated with Adalimumab (46.9%) and Infliximab (39.9%) as their first biologic treatment. After 12 months, 72.2% of patients were still persistent with their initial biologic treatment with the highest shares for Infliximab (74%) and Vedolizumab (72.4%). 27.8% of patients were nonpersistent, mostly due to a switch of biologic agent (75.8%). Cox regression identified female, hospitalizations, and simultaneous prescriptions of corticosteroids and immunomodulators as risk factors for nonpersistence. Treatment costs per year were approximately 3000€ higher for nonpersistent patients (27,146€) than for persistent patients (23,839€), mostly due to inpatient treatment costs.
The persistence of biologic therapy in this study was rather high at 72% after 12 months, while nonpersistence was mostly due to switches to other biologic agents. Lack of persistence is associated with increased cost, mostly due to nonbiologic medication and inpatient treatment.
近年来，生物制剂成为炎症性肠病（IBD）一种相关且有前景的治疗选择。然而，高昂的治疗成本和中等的缓解率引发了对治疗持续性及相应经济后果的高度关注。
进行了一项回顾性健康索赔数据分析，纳入了2013年至2018年间诊断为IBD且未使用过生物制剂的患者。观察点为从首次生物制剂处方开始的12个月和18个月随访时。非持续性定义为在原处方的供应天数内没有进一步处方或处方了另一种生物制剂。纳入的生物制剂包括阿达木单抗、戈利木单抗、英夫利昔单抗、乌司奴单抗和维多珠单抗。
本分析共纳入1444例IBD患者，大多数患者首次生物治疗使用阿达木单抗（46.9%）和英夫利昔单抗（39.9%）。12个月后，72.2%的患者仍持续接受初始生物治疗，其中英夫利昔单抗（74%）和维多珠单抗（72.4%）的比例最高。27.8%的患者治疗不持续，主要原因是更换生物制剂（75.8%）。Cox回归分析确定女性、住院治疗以及同时使用皮质类固醇和免疫调节剂是治疗不持续的危险因素。非持续性患者每年的治疗成本（27,146欧元）比持续性患者（23,839欧元）高出约3000欧元，主要是由于住院治疗成本。
本研究中生物治疗的持续性在12个月时相当高，为72%，而非持续性主要是由于更换为其他生物制剂。治疗不持续与成本增加相关，主要是由于非生物药物和住院治疗。
