Su1212 Incidence of Surgery and Associated Costs At 1 and 2 Years in Patients Newly Initiated to a Subcutaneous Anti-TNF for the Treatment of Crohn's Disease

Abstract

BACKGROUNDCrohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. For patients with severe CD, uncontrolled inflammation can result in a high incidence of long-term complications, including surgery.[1] Anti-tumor necrosis factor-α (anti-TNF) therapy is indicated for patients with CD who have an inadequate response to conventional therapy. The aim of this analysis is to evaluate the incidence of CD-related surgery and the associated costs at 1 and 2 years in patients with CD prescribed an anti-TNF agent administered subcutaneously (adalimumab [ADA]) or certolizumab pegol [CZP]). METHODS OptumInsight's Clinformatics Data Mart, a database of administrative health claims from a large national health insurer, was used for the analysis. US patients were identified with a diagnosis of CD and receipt of an anti-TNF prescription of ADA or CZP from April 2008January 2012. Patients were eligible for inclusion in the analysis if they were aged ≥18 years with a diagnosis of CD, had not received anti-TNF therapy in the 6 months prior to first anti-TNF, and had 24 months' pharmacy and medical continuous enrollment in the database. The number of patients prescribed ADA or CZP who had surgery for CD during a 1-year or 2-year study period was evaluated. Average (mean) and median CD-specific costs (including CD-related medications, visits, and surgeries) and total costs (CD-specific plus all other associated costs [including visits and laboratory tests]) were also assessed. RESULTS There were 273 ADA patients and 75 CZP patients identified who met the inclusion criteria. No differences in the incidence of CD surgery during a 1and 2-year study period were observed for patients initiated on ADA or CZP (Table). Average (mean) CD-specific costs and total costs for patients initiated on ADA or CZP during a 1and 2-year study period are shown in the Table. Median CD-specific costs for patients initiated on ADA and CZP were $26,987 and $26,744 at 1 year and $52,928 and $45,292 at 2 years. Median total costs were $29,950 and $30,490 at 1 year and $59,329 and $50,432 at 2 years. CONCLUSIONS This analysis of a US claims database showed that over 1 and 2 years, the incidence of CD surgery was similar for patients prescribed ADA or CZP. The 2-year incidence of CD surgery with a subcutaneous anti-TNF (11%-12%) appears to be lower than that seen in the general CD population.[1] CD-specific and overall claims costs were similar for ADA or CZP at 1 year; at 2 years, costs were found to be slightly higher in the ADA treatment group. Limitations of this analysis were the inability to account for disease severity and the low number of patients with available claims at 2 years. REFERENCE 1. Peyrin-Biroulet L, et al. Am J Gastroenterol 2012;107:1693-701. Table