Introduction
There is limited research on HealthCare Resource Utilization (HCRU) and costs among patients receiving ustekinumab (UST) treatment. This study aims to evaluate HCRU and costs in patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) who received UST treatment through Janssen’s BIOADVANCE® patient support program (PSP) in Ontario, Canada.
Aims & Methods
The primary objective of this study is to compare annual HCRU and costs (excluding medication expenses) during a period of one year before initiating UST treatment and up to four years post-initiation.
This retrospective observational study analyzed data from a consecutive cohort of Ontario CD and UC patients who initiated UST treatment through Janssen’s BIOADVANCE® PSP.
Patients were indexed based on their first recorded UST prescription fill, spanning from January 1, 2017, to July 31, 2021, for CD patients, and from February 1, 2020, to July 31, 2021, for UC patients.
Quasi-identifiers (date of birth, gender, postal code, indication) were used for probabilistic linkage of patients in BIOADVANCE® PSP to those in Ontario Crohn’s and Colitis Cohort (OCCC) from the Institute for Clinical Evaluative Sciences (ICES). A follow-up period for up to four years post-index date was used to assess all-cause and IBD-specific HCRU and costs. A 12-month lookback period was utilized to establish baseline demographic and clinical profiles and baseline HCRU and costs. A mixed gamma regression model was employed to compare costs before and after UST initiation. IBD-specific HCRU and costs included general practitioner visits, specialist visits, emergency department visits, inpatient hospitalization, and same-day surgeries. IBD-specific HCRU and costs were identified based on the IBD-specific diagnosis code as the most responsible diagnosis.
Results
A probabilistic linkage of 88.1% for CD cases and UC cases was achieved. A total of 2,279 patients with CD and 626 patients with UC were included. UST was the initial biologic therapy for 35.72% and 22.68% of patients with CD and UC, respectively. The average time since diagnosis was 10.72 years for CD and 8.07 years for UC. The mean age was 45.6 ± 17.2 years for UC patients and 45.7 ± 16.2 years for CD patients. UC showed a male-female ratio of 56% to 44%, whereas for CD, it was 46% to 54%.
IBD-specific HCRU and costs significantly decreased post-UST initiation in Years 1, 2, and 3 for both CD patients and UC patients, compared to baseline.
[See Table]
| IBD Specific Costs ($ CAD) Mean +/- (SD) | Year 1 | p-value | Year 2 | p-value | Year 3 | p-value |
| Crohn's Disease | (n) | n=2,279 | 0.0057 | n=1,659 | <0.0001 | n=1,057 | <0.0001 |
| Baseline (BL) | 2,754 ± 6,025 | 2,851 ± 6,361 | 2,861 ± 6,428 |
| Follow-up (FU) | 2,206 ± 7,550 | 1,644 ± 5,300 | 1,417 ± 5,194 |
| Ulcerative Colitis | (n) | n=626 | 0.0203 | n=317 | <0.0001 | n=49 | 0.0037 |
| Baseline (BL) | 3,373 ± 6,745 | 3,910 ± 8,051 | 6,277 ± 11,499 |
| Follow-up (FU) | 2,535 ± 7,865 | 1,491 ± 4,808 | 1,335 ± 4,121 |
Specifically in Year 2, inpatient hospitalization cost was reduced by 43.7% for CD (BL $1,642 vs. FU $925, p= 0.0001) and 67.3% for UC (BL $2,315 vs. FU $756, p= 0.0011). Total physician visit cost was reduced by 33.6% for CD (BL $728 vs. FL $483, p<0.0001) and 45.8% for UC (BL $858 vs. FL $465, p= <0.0001).
Conclusion
Initiation of UST through the BIOADVANCE® PSP was related to substantial reductions in IBD-specific HCRU and costs among patients with CD and UC in Ontario, Canada. These findings underscore the potential benefits of UST as an advanced therapy in IBD treatment, in managing CD and UC, and support its role in optimizing patient outcomes while reducing the burden on healthcare resources.
References
Data source:
- Janssen BIOADVANCE® Database (January 1, 2016 – March 31, 2023) and Ontario Crohn’s and Colitis Cohort (OCCC) data in Institute for Clinical Evaluative Sciences (ICES).
Disclosure
Laura Targownik has received grants from AbbVie Canada, Janssen Canada and Pfizer Canada; consulting fees from AbbVie, Takeda, Janssen, Pfizer, Amgen, Viatris, Fresenius Kabi, Bristol Myers Squibb, Sanofi, Lilly; honoraria from AbbVie, Takeda, Janssen, Pfizer, Amgen, Viatris, Fresenius Kabi, Bristol Myers Squibb, Sanofi; has participated on a data safety monitoring board of advisory board for GoodCap Pharmaceuticals, Pfizer, Takeda, Janssen, Bristol Myers Squibb, and is a member of the Crohn’s and Colitis Canada Scientific and Medical Advisory Board; Eneda Pone, Martin G. Latour, and Kasra Boyerahmadi are Janssen employee, and Huijuan Yang, Juejing Ling, Ali Tehrani, and Shane Golden are employee of IQVIA, and John K Marhsall is a consultant for AbbVie, Amgen, Bausch Health, Bristol Myers Squibb, Celltrion, Ferring, Fresenius Kabi, Janssen, Lilly, Organon, Paladin, Pfizer, Pharmascience, Roche, Sandoz, Takeda, Viatris and a speaker for AbbVie, Amgen, Bausch Health, Ferring, Fresenius Kabi, Janssen, Lupin, Organon, Pfizer, Pharmascience, Roche, Takeda.
