Abstract
BackgroundChronic inflammatory diseases (CIDs; ankylosing spondylitis [AS], psoriatic arthritis [PsA], psoriasis [PsO], or rheumatoid arthritis [RA]) and inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis) are associated with substantial economic burden. The relative increased costs among patients with CIDs and concomitant IBD compared to those without IBD is an important consideration when deciding on the clinical management of patient symptoms. Given the increasing use of novel agents for the treatment of CIDs, including those that may increase the risk of IBD in patients with CIDs, the objective of the study was to describe the incidence of IBD and to quantify healthcare resource utilization (HRU) and costs associated with IBD among patients with CIDs.MethodsThe IBM MarketScan® Research Databases (1/2010–7/2017) were used to identify adult patients with ≥2 claims with a diagnosis of either AS/PsA/PsO/RA (index date was a random claim for AS/PsA/PsO/RA). The one-year incidence rate of IBD was calculated following the index date. HRU and healthcare costs were compared between patients developing and not developing IBD in the year following the index date, adjusting for baseline characteristics.ResultsA total of 537,450 patients with CIDs (mean age = 54.0 years; 63.1% female) were included in the study. The 1-year incidence rate of IBD was 0.52% (range = 0.39% in patients with PsO but without PsA to 1.73% in patients with AS). Patients who developed IBD (N = 2778) had significantly higher rates of inpatient, outpatient, and emergency room visits (incidence rate ratios [IRR] = 2.91, 1.35, 1.81; all P < 0.0001), compared to patients without IBD (N = 534,672). Patients who developed IBD had $18,500 (P < 0.0001) higher total costs per year, including $15,121 (P < 0.0001) higher medical costs and $3380 higher pharmacy costs (P < 0.0001).ConclusionHigher HRU and costs were observed in patients with concomitant CID and IBD compared to patients with CID alone. Consideration should be given to treatment decisions that adequately manage CID and IBD to ensure optimal clinical and economic outcomes.
Highlights
Chronic inflammatory diseases (CIDs; ankylosing spondylitis [AS], psoriatic arthritis [PsA], psoriasis [PsO], or rheumatoid arthritis [RA]) and inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis) are associated with substantial economic burden
Between the RA, PsO with PsA, PsO without PsA, and AS patient cohorts, 3280 patients were both in the RA and PsO with PsA cohorts, 3310 patients were both in the RA and PsO without PsA cohorts, 2957 patients were both in the RA and AS cohorts, 276 patients were both in the PsO with PsA and AS cohorts, and 288 patients were both in the PsO without PsA and AS cohorts
In the other condition-specific cohorts, mean age ranged from 49.4 years in the AS cohort to 57.5 years in the RA cohort, and the proportion of female patients ranged from 51.3% in the AS, PsO or PsA cohort to 75.8% in the RA cohort
Summary
Chronic inflammatory diseases (CIDs; ankylosing spondylitis [AS], psoriatic arthritis [PsA], psoriasis [PsO], or rheumatoid arthritis [RA]) and inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis) are associated with substantial economic burden. Given the increasing use of novel agents for the treatment of CIDs, including those that may increase the risk of IBD in patients with CIDs, the objective of the study was to describe the incidence of IBD and to quantify healthcare resource utilization (HRU) and costs associated with IBD among patients with CIDs. Inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis) is characterized by chronic inflammation of the gastrointestinal tract and is a common extraarticular manifestation in patients with chronic inflammatory diseases (CIDs), such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), psoriasis (PsO), and to a lesser extent in patients with rheumatoid arthritis (RA) [1,2,3,4]. The use of certain biologic therapies such as etanercept (a tumor necrosis factor inhibitor) and interleukin-17 (IL-17) antagonists in patients with CIDs is cautioned due to possible increased risk of IBD [16,17,18,19,20,21,22]
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