Abstract
BackgroundThere has been an increase in incidence and prevalence of inflammatory bowel disease (IBD) outside the western countries. Treatment costs are an essential component for healthcare planning and priority setting. The utilization patterns and annual administration and cost of IBD medications are largely unknown in countries with an increasing incidence of disease, Saudi Arabia being an example.AimTo evaluate the use of non-biologic and biologic agents and their associated annual administration costs in a sample of patients with Crohn’s disease (CD) and ulcerative colitis (UC) in Saudi Arabia.MethodsSingle-center retrospective chart review was performed to determine the use of biologic and non-biologic medications among IBD patients in a tertiary care hospital in Riyadh, Saudi Arabia. Daily and the annual acquisition cost of different IBD therapeutic agents was calculated. The utilization rates and cost of each type of medication by CD and UC patients were compared.ResultsData of 258 CD patients and 249 UC patients were analyzed. Infliximab and adalimumab were the most commonly prescribed biologics among the study sample, however, their utilization rates were significantly higher among CD than UC patients (36.82% vs. 11.24%, and 20.54% vs. 9.64%, respectively, P < 0. 01). Azathioprine utilization rate was also higher among CD patients compared to their UC counterparts (71.71% vs. 40.16%, respectively, P < 0.01). However, the utilization rate of mesalazine in the UC patients was significantly higher than their CD counterparts (85.53% vs. 14.34% for CD, P < 0.01). The annual cost of biologics (including administration and lab test cost) ranged from 5572 USD for ustekinumab to 18,424 USD for vedolizumab. On the other hand, the annual cost of non-biologics ranged from 16 USD for prednisone to 527 USD for methotrexate.ConclusionBiologics are extensively used in the management of IBD, particularly CD, and their utilization costs are significantly higher than non-biologics. Future studies should examine the cost effectiveness of IBD medications especially in countries with increasing incidence such as Saudi Arabia.
Highlights
There has been an increase in incidence and prevalence of inflammatory bowel disease (IBD) outside the western countries
Infliximab and adalimumab were the most commonly prescribed biologics among the study sample, their utilization rates were significantly higher among Crohn’s disease (CD) than ulcerative colitis (UC) patients
The data on 693 IBD patients who have been seen over a period of 17 years in a single medical center have shown that approximately 34% of them were affected by UC and 66% by CD, and most of them were male [12]
Summary
There has been an increase in incidence and prevalence of inflammatory bowel disease (IBD) outside the western countries. The utilization patterns and annual administration and cost of IBD medications are largely unknown in countries with an increasing incidence of disease, Saudi Arabia being an example. A single published national multicenter study on IBD, carried out from 2003 to 2012, determined that the incidence rate among pediatric patients (0–14 years) was 0.2, 0.27, and 0.47 per 100,000 individuals for UC, CD, and IBD, respectively [10]. Another investigation, based on a retrospective review of medical records from 1983 to 2002 in a single center, established that the annual incidence rate was 0.94 per 100,000 individuals [11]. The majority of CD patients were young (e.g., 17–40 years of age) according to a multi-center study that explored the characteristics of CD patients in Saudi Arabia, the majority of patients were male [15]
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