Resource utilization before and during infliximab therapy in patients with inflammatory bowel disease

Abstract

Objective:

Although Remicade (infliximab) is costly relative to non-biologic therapy, its impact on healthcare resource utilization and mucosal healing may make it a cost-effective option. This study aimed to compare gastrointestinal (GI)-related healthcare resource utilization and severity of mucosal damage before and during infliximab therapy in Crohn’s disease (CD) or ulcerative colitis (UC) patients.

Methods:

A retrospective chart review was conducted at 14 gastroenterology practices from across the country, which varied in practice sizes and types. Patients were aged ≥18 years, diagnosed with CD or UC, and had an infliximab index date between January 1, 2005 and September 30, 2007. GI-related utilization 12 months before and 12 months after the index date was compared. Endoscopic disease severity was categorized based on blinded review of abstracted reports.

Results:

Results from 268 patients indicated significantly lower rates of surgery (29.7% to 9.9%, p < 0.0001, CD; 24.4% to 12.8%, p = 0.042, UC) and colonoscopy (54.4% to 17.6%, p < 0.0001, CD; 50.0% to 22.1%, p = 0.0007, UC) during infliximab therapy. The rates of hospitalizations in UC (15.1% to 3.5%, p = 0.0124) and radiology assessments in CD (23.1% to 10.4%, p = 0.006) also decreased. Based on severity data from 183 procedures, greater proportions of patients had normal or mild ratings during infliximab treatment compared with pre-treatment.

Limitations:

This retrospective descriptive study is limited by the type and quantity of information available in patient charts from 14 gastroenterology clinics during the first year of infliximab treatment. In addition, the number of patients with pre-treatment and post-treatment disease severity information was too small to make comparisons among disease severity groups. Further information about the severity of disease and the extent of mucosal healing could be helpful in determining the effect of therapy on resource utilization in future research.

Conclusions:

GI-related resource utilization was significantly lower and attenuation of mucosal damage severity was observed during infliximab treatment compared with the pre-treatment period.

Key words::

• Infliximab
• Inflammatory bowel disease
• Resource utilization

Transparency

Declaration of funding

This study was supported by Janssen Scientific Affairs, LLC, Horsham, PA.

Declaration of financial/other relationships

J. E. Vanderpoel, B. Nejadnik, and R. S. McKenzie are employees of Janssen Scientific Affairs, LLC. H. C. Waters was an employee of Janssen Scientific Affairs, LLC, at the time at which this research was conducted and is currently employed by Ethicon, Inc. H. C. Waters was involved in study design, interpretation of data, and preparation and review of the manuscript; R. S. McKenzie was involved in study design, interpretation of data, and review of the manuscript; J. E. Vanderpoel was involved in interpretation of data and preparation and review of the manuscript; B. Nejadnik provided blinded review of endoscopic data, interpreted clinical data, and reviewed the manuscript. O. Lunacsek (statistical analysis) and B. J. Lennert (study coordinator) are employed by Xcenda, LLC, which has a consultant relationship with Janssen Scientific Affairs, LLC. J. Goff and D. H. Augustyn served as scientific advisors to the project and were compensated for their review of the study design and manuscript.

Acknowledgments

The authors wish to thank the following Xcenda, LLC, staff who assisted in the preparation of this article: Alberto Vigo, RN, MSN, and Tim Frank, CPC, LPTA, chart reviewers, and Luther Hill, software engineer, who programmed the Microsoft Access data collection tool. Gianna Paone and Robert Achenbach of Janssen Services, LLC, provided editorial and submission support.