PHS80 - Surgery and biologic use pattern for patients with crohn's disease who initiated tnf antagonists in a managed care setting in the United States

Abstract

To determine patient demographics and treatment patterns in patients with Crohn’s Disease (CD) who initiated biologic treatment with a TNF antagonist (infliximab or adalimumab). Patients ≥ 18 years with CD (ICD-9:555.X) who initiated a TNF antagonist between January 2007 and December 2008 were identified from the US IMPACT health insurance claims database. Two cohorts were identified; those who received CD related surgery (CDSURG) within a 24-month follow-up and those who did not (CDNon-SURG). Patients continuously enrolled for medical and pharmacy benefits during 6 months prior to their first TNF antagonist claim (index claim). A total of 812 individuals with CD were followed over a 24-month period, of which 92% were CDNon-SURG and 8% were CDSURG patients. The majority of patients (89%) were 18 to 54 years old with a higher portion of CDSURG patients in the 18-34 age range. CDSURG included younger patients (mean age: 37 yrs) and a lower percent of females (48%) compared to CDNon-SURG (41 yrs; 59% female). CDSURG patients had higher hospitalization rates (38%) and incurred more health care expenditures ($15,112) during baseline compared to CDNon-SURG patients (23%; $13,400). During the last 6 months of follow-up, the percentage of CDSURG patients on biologics dropped to 44%; of the 56% in CDSURG who discontinued biologics, 31% received no treatment. In contrast, the percentage of CDNon-SURG patients continuing biologics decreased to 67% with 37% remaining on a “biologic only.” Most CD patients (92%) initiated on biologics did not require surgery, however about one third stopped TNF antagonist treatment over 24 months. Although 8% of CD patients underwent surgery, they incurred high direct and indirect costs even prior to surgery. Even with availability of TNF antagonists, due to high discontinuation rate, there is an unmet need of effective CD treatment options that may delay or prevent disease progression.