Payer-Addressable Burden of Crohn’s Disease in Members Treated with Biologics in the United States: Actuarial Analysis Findings from RAINBOW

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© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC

TABLE 1 Demographics of Overall and Biologic-Naive Members

		Vedolizumab	Ustekinumab	Infliximab	Adalimumab
2017	Treated, n (% of total number of members treated with biologics)	979 (10.66)	655 (7.14)	3741 (40.75)	3805 (41.45)
	Age 18–44 years, n (%)	574 (58.63)	387 (59.08)	2446 (65.38)	2297 (60.37)
	Age 45–64 years, n (%)	365 (37.28)	257 (39.24)	1182 (31.60)	1385 (36.40)
	Age 65–74 years, n (%)	NS^a	NS^a	98 (2.62)	114 (3.00)
	Age 75–84 years, n (%)	NS^a	NS^a	NS^a	NS^a
	Age 85+ years, n (%)	NS^a	NS^a	NS^a	NS^a
	Biologic naive, n (% of treated)	350 (35.75)	226 (34.50)	1227 (32.79)	1611 (42.34)
2018	Treated, n (% of total number of members treated with biologics)	1225 (11.93)	1216 (11.84)	3793 (36.94)	4035 (39.29)
	Age 18–44 years, n (%)	734 (59.92)	728 (59.87)	2533 (66.78)	2482 (61.51)
	Age 45–64 years, n (%)	449 (36.65)	457 (37.58)	1164 (30.69)	1432 (35.49)
	Age 65–74 years, n (%)	NS^a	NS^a	81 (2.14)	111 (2.75)
	Age 75–84 years, n (%)	NS^a	NS^a	NS^a	NS^a
	Age 85+ years, n (%)	NS^a	NS^a	NS^a	NS^a
	Biologic naive, n (% of treated)	440 (35.92)	298 (24.51)	1209 (31.87)	1580 (39.16)
2019	Treated, n (% of total number of members treated with biologics)	1524 (13.54)	1775 (15.77)	3925 (34.86)	4035 (35.84)
	Age 18–44 years, n (%)	903 (59.25)	1067 (60.11)	2636 (67.16)	2504 (62.06)
	Age 45–64 years, n (%)	552 (36.22)	653 (36.79)	1167 (29.73)	1415 (35.07)
	Age 65–74 years, n (%)	56 (3.67)	NS^a	109 (2.78)	107 (2.65)
	Age 75–84 years, n (%)	NS^a	NS^a	NS^a	NS^a
	Age 85+ years, n (%)	NS^a	NS^a	NS^a	NS^a
	Biologic naive, n (% of treated)	527 (34.58)	375 (21.12)	1151 (29.32)	1424 (35.29)

Note: NS, not enough sample; SD, standard deviation.

^a Low member count.

TABLE 2 Clinical Characteristics of Overall and Biologic-Naive Members

		Vedolizumab	Ustekinumab	Infliximab	Adalimumab
2017	Adherent, n (% of total treated)	712 (72.73)	403 (61.53)	2760 (73.78)	2545 (66.89)
	Biologic naive and adherent, n (% of naive treated)	268 (76.57)	163 (72.12)	954 (77.75)	1122 (69.65)
	Adherence by age, n (% of age group)
	Age 18–44 years	408 (71.08)	236 (60.98)	1798 (73.51)	1470 (64.00)
	Age 45–64 years	278 (76.16)	162 (63.04)	896 (75.80)	994 (71.77)
	Age 65–74 years	NS^a	NS^a	53 (54.08)	74 (64.91)
	Age 75–84 years	NS^a	NS^a	NS^a	NS^a
	Age 85+ years	NS^a	NS^a	NS^a	NS^a
2018	Adherent, n (% of total treated)	914 (74.61)	828 (68.09)	2968 (78.25)	2746 (68.05)
	biologic naive and adherent (% of naive treated)	336 (76.36)	203 (68.12)	968 (80.07)	1173 (74.24)
	Adherence by age, n (% of age group)
	Age 18–44 years	550 (74.93)	491 (67.45)	1964 (77.54)	1625 (65.47)
	Age 45–64 years	340 (75.72)	316 (69.15)	944 (81.10)	1036 (72.35)
	Age 65–74 years	NS^a	NS^a	52 (64.20)	77 (69.37)
	Age 75–84 years	NS^a	NS^a	NS^a	NS^a
	Age 85+ years	NS^a	NS^a	NS^a	NS^a
2019	Adherent, n (% of total treated)	1182 (77.56)	1115 (62.82)	3003 (76.51)	2783 (68.97)
	Biologic naive and adherent, n (% of naive treated)	421 (79.89)	255 (68.00)	898 (78.02)	1045 (73.38)
	Adherence by age, n (% of age group)
	Age 18–44 years	694 (76.85)	675 (63.26)	1991 (75.53)	1676 (66.93)
	Age 45–64 years	434 (78.62)	406 (62.17)	937 (80.29)	1028 (72.65)
	Age 65–74 years	NS^a	NS^a	67 (61.46)	75 (70.09)
	Age 75–84 years	NS^a	NS^a	NS^a	NS^a
	Age 85+ years	NS^a	NS^a	NS^a	NS^a

Note: NS, not enough sample; SD, standard deviation.

^a Low member count.

TABLE 3 CD-Related Costs in Overall and Biologic-Naive Members Between 2017 and 2019

		Weighted mean costs per treated member per year (proportion of total allowed amount, %)
Population	Year	Inpatient^a	Outpatient^b	Physician^c	Pharmacy med^d	Pharmacy Rx^e	Other^f	Total allowed amount^g	Members, n	PMPM
Vedolizumab
All members	2017	$4163 (8.39)	$5961 (12.02)	$2429 (4.90)	$34,000 (68.55)	$2953 (5.95)	$94 (0.19)	$49,600 (100)	979	$0.31
	2018	$3327 (6.75)	$4166 (8.45)	$2275 (4.61)	$36,745 (74.51)	$2684 (5.44)	$115 (0.23)	$49,313 (100)	1225	$0.39
	2019	$3037 (5.51)	$3585 (6.50)	$2182 (3.96)	$42,236 (76.58)	$4004 (7.26)	$109 (0.20)	$55,152 (100)	1524	$0.53
	Mean	$3439 (6.65)	$4422 (8.55)	$2280 (4.41)	$38,176 (73.84)	$3280 (6.34)	$107 (0.21)	$51,704 (100)	1243	$0.41
Biologic naive	2017	$3505 (8.84)	$6292 (15.87)	$2044 (5.16)	$27,626 (69.69)	$143 (0.36)	$35 (0.09)	$39,644 (100)	350	$0.09
	2018	$3441 (9.04)	$3792 (9.97)	$2001 (5.26)	$28,687 (75.39)	$0 (0.00)	$129 (0.34)	$38,049 (100)	440	$0.11
	2019	$2498 (5.87)	$3905 (9.18)	$1863 (4.38)	$34,060 (80.03)	$151 (0.35)	$84 (0.20)	$42,560 (100)	527	$0.14
	Mean	$3110 (7.74)	$4537 (11.30)	$1962 (4.88)	$30,375 (75.62)	$96 (0.24)	$86 (0.21)	$40,166 (100)	439	$0.11
Ustekinumab
All members	2017	$7123 (7.57)	$5622 (5.98)	$2738 (2.91)	$12,597 (13.39)	$65,954 (70.11)	$32 (0.03)	$94,067 (100)	655	$0.39
	2018	$4771 (4.51)	$3917 (3.71)	$2134 (2.02)	$7486 (7.08)	$87,326 (82.60)	$86 (0.08)	$105,721 (100)	1216	$0.84
	2019	$3869 (3.17)	$3892 (3.19)	$1908 (1.57)	$6832 (5.60)	$105,249 (86.33)	$165 (0.14)	$121,915 (100)	1775	$1.37
	Mean	$4762 (4.27)	$4215 (3.78)	$2135 (1.92)	$8097 (7.27)	$92,099 (82.66)	$115 (0.10)	$111,422 (100)	1215	$0.86
Biologic naive	2017	$6810 (9.26)	$3580 (4.87)	$1847 (2.51)	$6130 (8.34)	$55,041 (74.86)	$117 (0.16)	$73,525 (100)	226	$0.10
	2018	$4403 (5.07)	$3827 (4.41)	$1501 (1.73)	$1594 (1.84)	$75,340 (86.78)	$150 (0.17)	$86,816 (100)	298	$0.17
	2019	$2846 (2.76)	$3695 (3.59)	$1390 (1.35)	$2913 (2.83)	$92,095 (89.43)	$45 (0.04)	$102,985 (100)	375	$0.23
	Mean	$4473 (5.01)	$3710 (4.16)	$1554 (1.74)	$3326 (3.73)	$76,111 (85.25)	$102 (0.11)	$89,276 (100)	300	$0.17
Infliximab
All members	2017	$2072 (4.68)	$3336 (7.54)	$2080 (4.70)	$35,882 (81.05)	$805 (1.82)	$94 (0.21)	$44,269 (100)	3741	$1.07
	2018	$1604 (3.41)	$3685 (7.82)	$2139 (4.54)	$38,682 (82.12)	$797 (1.69)	$198 (0.42)	$47,104 (100)	3793	$1.16
	2019	$1664 (3.52)	$3329 (7.05)	$2222 (4.71)	$38,801 (82.17)	$1134 (2.40)	$70 (0.15)	$47,221 (100)	3925	$1.14
	Mean	$1782 (3.86)	$3450 (7.47)	$2146 (4.65)	$37,772 (81.79)	$910 (1.97)	$121 (0.26)	$46,182 (100)	3820	$1.12
Biologic naive	2017	$3422 (9.02)	$3701 (9.76)	$2069 (5.46)	$28,491 (75.13)	$144 (0.38)	$95 (0.25)	$37,920 (100)	1227	$0.30
	2018	$2679 (7.06)	$4187 (11.03)	$2091 (5.51)	$28,692 (75.62)	$28 (0.07)	$265 (0.70)	$37,943 (100)	1209	$0.30
	2019	$2787 (6.96)	$4363 (10.90)	$2371 (5.92)	$30,354 (75.85)	$66 (0.16)	$76 (0.19)	$40,017 (100)	1151	$0.27
	Mean	$2984 (7.75)	$4056 (10.53)	$2161 (5.61)	$29,080 (75.51)	$81 (0.21)	$150 (0.39)	$38,511 (100)	1196	$0.29
Adalimumab
All members	2017	$1882 (3.66)	$1195 (2.32)	$1159 (2.25)	$491 (0.95)	$46,720 (90.81)	$2 (0.00)	$51,450 (100)	3805	$1.26
	2018	$1669 (2.99)	$1363 (2.44)	$1064 (1.91)	$515 (0.92)	$51,215 (91.73)	$8 (0.01)	$55,834 (100)	4035	$1.46
	2019	$1778 (2.75)	$1430 (2.21)	$1110 (1.72)	$540 (0.83)	$59,850 (92.48)	$8 (0.01)	$64,716 (100)	4035	$1.66
	Mean	$1775 (3.09)	$1330 (2.32)	$1110 (1.94)	$515 (0.90)	$52,617 (91.74)	$6 (0.01)	$57,354 (100)	3958	$1.45
Biologic naive	2017	$2376 (5.54)	$1372 (3.20)	$1233 (2.87)	$92 (0.21)	$37,825 (88.17)	$3 (0.01)	$42,901 (100)	1611	$0.45
	2018	$2297 (5.07)	$1768 (3.90)	$1161 (2.56)	$102 (0.23)	$39,981 (88.23)	$6 (0.01)	$45,316 (100)	1580	$0.46
	2019	$2239 (4.33)	$1753 (3.39)	$1353 (2.62)	$90 (0.17)	$46,298 (89.49)	$5 (0.01)	$51,738 (100)	1424	$0.46
	Mean	$2309 (4.99)	$1619 (3.50)	$1243 (2.68)	$95 (0.21)	$41,024 (88.61)	$5 (0.01)	$46,295 (100)	1538	$0.46

Note: CD, Crohn’s disease; HCP, health care professional; PMPM, per member per month; Rx, prescription. The sum of inpatient, outpatient, physician, pharmacy, and other costs may not fully align with total allowed amount owing to rounding.

^a Costs associated with an inpatient facility, excluding HCP-administered drugs, durable medical equipment, transportation, and physician services; includes home health and hospice care.

^b Costs associated with an outpatient facility, excluding HCP-administered drugs, durable medical equipment, transportation, and physician services.

^c Costs associated with physician service both in and out of a facility setting.

^d Pharmacy costs associated with HCP-administered drugs.

^e Pharmacy costs associated with prescription drugs.

^f Costs not classified above as inpatient, outpatient, physician, or pharmacy (e.g., durable medical equipment and transportation).

^g The portion of submitted charges covered under plan benefits. This is the amount after discounts and excluded expenses, and before employee and member responsibility (e.g., benefits limitations, co-pay amounts). Costs presented are before rebates.

TABLE 4 CD-Related Costs in Overall and Biologic-Naive, Treatment-Adherent Members Between 2017 and 2019

		Weighted mean costs per treated member per year (proportion of total allowed amount, %)
Population	Year	Inpatient^a	Outpatient^b	Physician^c	Pharmacy med^d	Pharmacy Rx^e	Other^f	Total allowed amount^g	Members, n	PMPM
Vedolizumab
All adherent members	2017	$3459 (6.82)	$3783 (7.45)	$2426 (4.78)	$37,924 (74.73)	$3118 (6.14)	$34 (0.07)	$50,745 (100)	712	$0.23
	2018	$2193 (4.15)	$3859 (7.30)	$2266 (4.28)	$41,828 (79.09)	$2655 (5.02)	$87 (0.16)	$52,887 (100)	914	$0.31
	2019	$2319 (4.03)	$2937 (5.10)	$2223 (3.86)	$46,104 (80.05)	$3944 (6.85)	$65 (0.11)	$57,593 (100)	1182	$0.44
	Mean	$2570 (4.73)	$3452 (6.36)	$2289 (4.21)	$42,625 (78.47)	$3315 (6.10)	$64 (0.12)	$54,317 (100)	936	$0.33
Biologic naive and adherent	2017	$3162 (7.98)	$4444 (11.22)	$2043 (5.16)	$29,943 (75.59)	$0 (0.00)	$18 (0.05)	$39,610 (100)	268	$0.07
	2018	$2630 (6.62)	$3618 (9.11)	$2047 (5.16)	$31,284 (78.79)	$0 (0.00)	$128 (0.32)	$39,705 (100)	336	$0.09
	2019	$1846 (4.25)	$3178 (7.31)	$1836 (4.22)	$36,339 (83.57)	$185 (0.43)	$101 (0.23)	$43,485 (100)	421	$0.11
	Mean	$2474 (6.01)	$3675 (8.93)	$1965 (4.78)	$32,862 (79.89)	$71 (0.17)	$87 (0.21)	$41,134 (100)	342	$0.09
Ustekinumab
All adherent members	2017	$5796 (5.93)	$4829 (4.94)	$2520 (2.58)	$13,569 (13.88)	$71,015 (72.63)	$42 (0.04)	$97,771 (100)	403	$0.25
	2018	$3939 (3.40)	$4080 (3.52)	$2113 (1.82)	$8708 (7.52)	$96,875 (83.63)	$116 (0.10)	$115,832 (100)	828	$0.62
	2019	$3221 (2.43)	$4011 (3.02)	$1868 (1.41)	$9321 (7.02)	$114,273 (86.08)	$64 (0.05)	$132,758 (100)	1115	$0.96
	Mean	$3911 (3.23)	$4175 (3.45)	$2065 (1.71)	$9836 (8.14)	$100,842 (83.41)	$78 (0.06)	$120,906 (100)	782	$0.60
Biologic naive and adherent	2017	$5789 (7.89)	$3254 (4.44)	$1820 (2.48)	$6424 (8.76)	$55,896 (76.22)	$156 (0.21)	$73,339 (100)	163	$0.07
	2018	$3114 (3.30)	$3886 (4.12)	$1333 (1.41)	$1907 (2.02)	$83,881 (88.93)	$203 (0.22)	$94,324 (100)	203	$0.13
	2019	$1956 (1.73)	$3993 (3.54)	$1330 (1.18)	$3739 (3.32)	$101,694 (90.17)	$65 (0.06)	$112,778 (100)	255	$0.17
	Mean	$3432 (3.60)	$3748 (3.93)	$1469 (1.54)	$3867 (4.06)	$82,702 (86.73)	$138 (0.14)	$95,357 (100)	207	$0.12
Infliximab
All adherent members	2017	$1889 (3.89)	$2960 (6.09)	$2271 (4.67)	$40,548 (83.41)	$874 (1.80)	$71 (0.15)	$48,612 (100)	2760	$0.86
	2018	$1532 (2.99)	$3118 (6.08)	$2321 (4.53)	$43,179 (84.26)	$909 (1.77)	$188 (0.37)	$51,247 (100)	2968	$0.99
	2019	$1428 (2.86)	$2775 (5.56)	$2297 (4.60)	$42,136 (84.46)	$1200 (2.41)	$52 (0.10)	$49,888 (100)	3003	$0.95
	Mean	$1611 (3.23)	$2950 (5.91)	$2297 (4.60)	$41,976 (84.06)	$998 (2.00)	$104 (0.21)	$49,935 (100)	2910	$0.93
Biologic naive and adherent	2017	$3196 (7.97)	$3242 (8.09)	$2176 (5.43)	$31,347 (78.20)	$79 (0.20)	$47 (0.12)	$40,088 (100)	954	$0.24
	2018	$2635 (6.71)	$3327 (8.47)	$2190 (5.58)	$30,865 (78.61)	$0 (0.00)	$247 (0.63)	$39,265 (100)	968	$0.25
	2019	$2528 (6.08)	$3439 (8.27)	$2399 (5.77)	$33,036 (79.49)	$69 (0.17)	$91 (0.22)	$41,562 (100)	898	$0.22
	Mean	$2808 (6.98)	$3328 (8.28)	$2244 (5.58)	$31,655 (78.72)	$48 (0.12)	$130 (0.32)	$40,214 (100)	940	$0.24
Adalimumab
All adherent members	2017	$1791 (3.04)	$1223 (2.08)	$1182 (2.01)	$519 (0.88)	$54,169 (91.99)	$2 (0.00)	$58,887 (100)	2545	$0.96
	2018	$1537 (2.42)	$1402 (2.20)	$1119 (1.76)	$578 (0.91)	$58,992 (92.71)	$7 (0.01)	$63,634 (100)	2746	$1.13
	2019	$1401 (1.97)	$1391 (1.95)	$1117 (1.57)	$610 (0.86)	$66,741 (93.65)	$9 (0.01)	$71,268 (100)	2783	$1.29
	Mean	$1570 (2.42)	$1341 (2.07)	$1138 (1.76)	$570 (0.88)	$60,159 (92.86)	$6 (0.01)	$64,785 (100)	2691	$1.12
Biologic naive and adherent	2017	$2427 (5.09)	$1375 (2.88)	$1298 (2.72)	$60 (0.13)	$42,534 (89.18)	$3 (0.01)	$47,697 (100)	1122	$0.34
	2018	$2538 (5.07)	$1825 (3.64)	$1219 (2.43)	$83 (0.17)	$44,414 (88.68)	$5 (0.01)	$50,084 (100)	1173	$0.38
	2019	$2028 (3.64)	$1670 (3.00)	$1348 (2.42)	$68 (0.12)	$50,521 (90.80)	$4 (0.01)	$55,640 (100)	1045	$0.37
	Mean	$2346 (4.61)	$1622 (3.19)	$1285 (2.52)	$71 (0.14)	$45,596 (89.54)	$4 (0.01)	$50,923 (100)	1113	$0.36

Note: CD, Crohn’s disease; HCP, health care professional; PMPM, per member per month; Rx, prescription. The sum of inpatient, outpatient, physician, pharmacy, and other costs may not fully align with total allowed amount owing to rounding.

^a Costs associated with an inpatient facility, excluding HCP-administered drugs, durable medical equipment, transportation, and physician services; includes home health and hospice care.

^b Costs associated with an outpatient facility, excluding HCP-administered drugs, durable medical equipment, transportation, and physician services.

^c Costs associated with physician service both in and out of a facility setting.

^d Costs associated with HCP-administered drugs and prescription drugs.

^e Pharmacy costs associated with prescription drugs.

^f Costs not classified above as inpatient, outpatient, physician, or pharmacy (e.g., durable medical equipment and transportation).

^g The portion of submitted charges covered under plan benefits. This is the amount after discounts and excluded expenses, and before employee and member responsibility (e.g., benefits limitations, co-pay amounts). Costs presented are before rebates.

DATA AVILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.