Earlier anti-TNF reduces health care utilization in CD
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Earlier administration of anti-tumor necrosis factor therapy reduced health care resource utilization in patients with Crohn’s disease but not in patients with ulcerative colitis, according to research.
“The direct costs of having these agents available for use continue to escalate and now make up the largest fraction of health care expenditures among IBD patients,” Laura E. Targownik, MD, MSHS, associate professor of gastroenterology and hepatology at the University of Toronto, and colleagues wrote. “Moreover, there is equivocal evidence as to whether the introduction of anti-TNFs as a treatment option has made a significant impact on hospitalization or surgery rates in the population, suggesting that these agents may not be optimally used in clinical practice.”
In a subsequent interview, Targownik told Healio, “We wanted to understand the long-term impact of earlier initiation of biologic therapy in persons with IBD.”
Targownik and colleagues sought to investigate and compare overall rates of health care utilization following anti-TNF initiation by evaluating 1,060 patients newly diagnosed with IBD (742 CD, 318 UC) using administrative health data from Manitoba, Canada. Collected data included rates of hospitalization, surgery and outpatient visits prior to and up to 5 years after anti-TNF initiation.
Researchers further compared health care utilization outcome rates between patients who received anti-TNFs within 2 years of their diagnosis (early initiators) and patients who received anti-TNFs more than 2 years after their diagnosis (late initiators). The median time from diagnosis to anti-TNF initiation was 4.43 years (IQR 1.31-12.16).
Among patients with CD, early initiators had a lower rate of IBD-specific hospitalizations in the third through fifth years following anti-TNF initiation as well as a lower rate of overall hospitalization in the fourth and fifth years following initiation.
Across all 5 years of follow-up, researchers noted that early initiators had a lower cumulative rate of IBD-specific hospitalizations (4 per 100 person-years vs. 8.6 per 100 person-years; incidence rate difference [IRD]: –4.5 per 100 person-years; 95% CI, –7 to –2.1) and all-cause hospitalizations (23.1 vs. 33.5; IDR: –10.4; 95% CI, –17 to –3.7). This group also had lower rates of IBD-specific surgical resection (IRD: –3.6; 95% CI, –5.3 to –1.9), overall outpatient visits (14.8 per year vs. 19.1 per year; IRD: –4.3; 95% CI, –5.4 to –3.2) and cumulative cost of care.
Among patients with UC, Targownik and colleagues noted no significant difference between early and late initiators for hospitalizations rates (IBD-specific: 3.8 vs. 5.9; all-cause: 26.5 vs. 24.1), cumulative surgery rates (7.7 vs. 6; IRD: 1.7; 95% CI, –2.5 to 5.9), outpatient visits or health care utilization cost.
“For patients with Crohn's disease, there is a significant reduction in IBD-related hospitalizations, surgeries and non-drug costs among persons who receive anti-TNFs within 2 years of diagnosis and these savings continue for at least 5 years following biologic initiation,” Targownik said. “We hope this provides more support for better coverage from payers for earlier access to these potentially disease modifying therapies.”
Targownik suggested additional research to investigate why the same effect was not seen among patients with UC.
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