Analysis Group Inc, Montreal, Canada.
Janssen Global Services LLC, Raritan, NJ, USA.
J Med Econ. 2024 Jan-Dec;27(1):931-940. doi: 10.1080/13696998.2024.2374645. Epub 2024 Jul 16.
Suboptimal treatment indicators, including treatment switch, are common among patients with Crohn's disease (CD), but little is known about their associated healthcare resource utilization (HRU) and costs. This study assessed the impact of suboptimal treatment indicators on HRU and costs among adults with CD newly treated with a first-line biologic.
Adult patients with CD were identified in the IBM MarketScan Commercial Subset (10/01/2015-03/31/2020). The index date was defined as initiation of the first-line biologic, and the study period was defined as the 12 months following the index date. Patients were classified into Suboptimal Treatment and Optimal Treatment cohorts based on observed indicators of suboptimal treatment during the study period. Patients in the Suboptimal Treatment Cohort with a treatment switch were classified into the Treatment Switch Cohort and compared to patients with no treatment switch. All-cause HRU and costs were measured during the study period and assessed for patients with suboptimal vs optimal treatment and patients with vs without a treatment switch.
The study included 4,006 patients (Suboptimal Treatment: 2,091, Optimal Treatment: 1,915). Treatment switch was a common indicator of suboptimal treatment (Treatment Switch: 640, No Treatment Switch: 3,366). HRU and costs were significantly higher among patients with suboptimal treatment than those with optimal treatment (annual costs: $92,043 vs $73,764; < 0.01), and among those with a treatment switch than those with no treatment switch (annual costs: $95,689 vs $81,027; < 0.01). Increases in the number of suboptimal treatment indicators were associated with increased costs.
Claims data were used to identify suboptimal treatment indicators based on observed treatment patterns; reasons for treatment decisions could not be assessed.
This study demonstrates that patients with suboptimal treatment indicators, including treatment switch, incur substantially higher HRU and costs compared to patients receiving optimal treatment and those that do not switch treatments.
包括治疗转换在内的治疗不充分指标在克罗恩病（CD）患者中较为常见，但有关其相关医疗资源利用（HRU）和成本的信息却很少。本研究评估了新接受一线生物制剂治疗的 CD 成人患者中治疗不充分指标对 HRU 和成本的影响。
在 IBM MarketScan 商业子集中（2015 年 10 月 1 日至 2020 年 3 月 31 日）确定 CD 成年患者。索引日期定义为一线生物制剂的起始日期，研究期间定义为索引日期后的 12 个月。根据研究期间观察到的治疗不充分指标，将患者分为治疗不充分和治疗充分队列。在治疗不充分队列中发生治疗转换的患者被分为治疗转换队列，并与无治疗转换的患者进行比较。在研究期间测量所有原因的 HRU 和成本，并评估治疗不充分和治疗充分患者以及有和无治疗转换患者的情况。
该研究纳入了 4006 名患者（治疗不充分：2091 名，治疗充分：1915 名）。治疗转换是治疗不充分的常见指标（治疗转换：640 名，无治疗转换：3366 名）。与治疗充分的患者相比，治疗不充分的患者的 HRU 和成本显著更高（年成本：92043 美元比 73764 美元；<0.01），且与无治疗转换的患者相比，有治疗转换的患者的 HRU 和成本更高（年成本：95689 美元比 81027 美元；<0.01）。治疗不充分指标数量的增加与成本的增加相关。
本研究使用索赔数据根据观察到的治疗模式来确定治疗不充分指标；无法评估治疗决策的原因。
本研究表明，与接受充分治疗的患者和未转换治疗的患者相比，存在治疗不充分指标（包括治疗转换）的患者的 HRU 和成本显著更高。
