Home-Based Infusions for Inflammatory Bowel Disease From the Provider and Patient Perspective

Abstract

Introduction: Biologic therapies for IBD include infusions typically administered in hospital settings. Home-based infusions are an alternative site of care associated with lower cost. We evaluated preferences and attitudes of patients and providers around decision-making related to site of care delivery for biologic infusions using conjoint analysis, a form of tradeoff analysis that determines how respondents make complex decisions by presenting them with competing scenarios. Methods: Patients and providers in the Crohn's and Colitis Foundation's multicenter IBD Qorus quality of care network were invited to participate online. Participants rated site of care attributes using conjoint analyses. In addition, providers rated additional variables they would want reported from home-based infusions. Multivariable regression was performed to identify factors associated with preferences Results: 317 patients (62% female) completed the survey. Over two thirds were currently on a biologic medication, including 37 who had experienced both in-hospital and home-based infusions. Of these, 73% preferred home infusions. In the conjoint analysis, patients prioritized travel time and personal cost per infusion, while proximity to an emergency room and risk of reactions were less important. Among providers (n=14), 86% had prescribed home infusions; none reported severe reactions at home, but 17% had patients who had experienced a mild infusion reaction at home. Provider concerns about home infusions included ordering pre-medications and less patient contact. Providers wanted more clinical information from the home setting including disease severity, weight changes, medication compliance, and patient concerns. In the conjoint analysis, providers prioritized a history of infusion reactions and presence of anti-drug antibodies when considering site of care; patient preferences were least important. Multivariable regression associated household income, travel time, and out of pocket cost per infusion with patient preferences for site of care. Conclusion: Most patients prefer home infusions, primarily based on convenience and financial considerations. Providers had concerns around decreased patient contact and medication ordering, and wanted additional information relayed back to them. When considering site of care, providers prioritized safety concerns over patient preference and cost,