Cargando…
Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization
BACKGROUND: Crohn’s disease (CD) is associated with major health services utilization and costs. Between 2012 and 2015, ustekinumab was used off-label in Quebec, Canada for treatment of refractory CD. AIMS: We assessed the direct medical cost of adult CD patients in the 1-year pre- and 1-year postus...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678737/ https://www.ncbi.nlm.nih.gov/pubmed/33241178 http://dx.doi.org/10.1093/jcag/gwz025 |
_version_ | 1783612217981140992 |
---|---|
author | Rahme, Elham Nedjar, Hacene Afif, Waqqas |
author_facet | Rahme, Elham Nedjar, Hacene Afif, Waqqas |
author_sort | Rahme, Elham |
collection | PubMed |
description | BACKGROUND: Crohn’s disease (CD) is associated with major health services utilization and costs. Between 2012 and 2015, ustekinumab was used off-label in Quebec, Canada for treatment of refractory CD. AIMS: We assessed the direct medical cost of adult CD patients in the 1-year pre- and 1-year postustekinumab initiation. METHODS: Data were obtained from the provincial administrative databases. CD patients dispensed subcutaneous ustekinumab in 2012 to 2014 were followed for 1 year from the date of initiation (index-date). Kaplan Meier plots were used to display time to ustekinumab discontinuation and factors associated with discontinuation were identified using multivariate Cox regression models. Direct medical costs and 95% confidence interval (CI) of gastrointestinal-related health services were calculated for the 1-year pre- and 1-year post-index-date. RESULTS: Thirty-four CD patients (mean age ± standard deviation, 44 ± 14 years, 59% women and 41% with low income) were included. Of these, 14 (41%) discontinued ustekinumab during the postperiod. Discontinuation was less likely among older patients: hazard ratio (95% CI) per 5-year age increase, 0.77 (0.61 to 0.96). The total $CAN direct medical cost (mean, 95% CI) was higher in the post- versus preperiod: $1,681,239 ($49,448; $42,265 to $57,160) versus $880,060 ($25,884; $20,391 to 31,596), while the total costs of GI-related health services were similar: $250,206 ($7359, $3536 to $11,674), versus $213,446 ($6278, $3609 to $9423). CONCLUSION: In patients with severe refractory CD on off-label ustekinumab, approximately 60% remained on treatment beyond 1 year. The cost of gastrointestinal services did not increase during that year as compared to that of the year preceding ustekinumab use. |
format | Online Article Text |
id | pubmed-7678737 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-76787372020-11-24 Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization Rahme, Elham Nedjar, Hacene Afif, Waqqas J Can Assoc Gastroenterol Original Articles BACKGROUND: Crohn’s disease (CD) is associated with major health services utilization and costs. Between 2012 and 2015, ustekinumab was used off-label in Quebec, Canada for treatment of refractory CD. AIMS: We assessed the direct medical cost of adult CD patients in the 1-year pre- and 1-year postustekinumab initiation. METHODS: Data were obtained from the provincial administrative databases. CD patients dispensed subcutaneous ustekinumab in 2012 to 2014 were followed for 1 year from the date of initiation (index-date). Kaplan Meier plots were used to display time to ustekinumab discontinuation and factors associated with discontinuation were identified using multivariate Cox regression models. Direct medical costs and 95% confidence interval (CI) of gastrointestinal-related health services were calculated for the 1-year pre- and 1-year post-index-date. RESULTS: Thirty-four CD patients (mean age ± standard deviation, 44 ± 14 years, 59% women and 41% with low income) were included. Of these, 14 (41%) discontinued ustekinumab during the postperiod. Discontinuation was less likely among older patients: hazard ratio (95% CI) per 5-year age increase, 0.77 (0.61 to 0.96). The total $CAN direct medical cost (mean, 95% CI) was higher in the post- versus preperiod: $1,681,239 ($49,448; $42,265 to $57,160) versus $880,060 ($25,884; $20,391 to 31,596), while the total costs of GI-related health services were similar: $250,206 ($7359, $3536 to $11,674), versus $213,446 ($6278, $3609 to $9423). CONCLUSION: In patients with severe refractory CD on off-label ustekinumab, approximately 60% remained on treatment beyond 1 year. The cost of gastrointestinal services did not increase during that year as compared to that of the year preceding ustekinumab use. Oxford University Press 2019-08-01 /pmc/articles/PMC7678737/ /pubmed/33241178 http://dx.doi.org/10.1093/jcag/gwz025 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Articles Rahme, Elham Nedjar, Hacene Afif, Waqqas Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization |
title | Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization |
title_full | Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization |
title_fullStr | Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization |
title_full_unstemmed | Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization |
title_short | Cost of Refractory Crohn’s Disease Before and After Ustekinumab Utilization |
title_sort | cost of refractory crohn’s disease before and after ustekinumab utilization |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678737/ https://www.ncbi.nlm.nih.gov/pubmed/33241178 http://dx.doi.org/10.1093/jcag/gwz025 |
work_keys_str_mv | AT rahmeelham costofrefractorycrohnsdiseasebeforeandafterustekinumabutilization AT nedjarhacene costofrefractorycrohnsdiseasebeforeandafterustekinumabutilization AT afifwaqqas costofrefractorycrohnsdiseasebeforeandafterustekinumabutilization |