Costs support infliximab as first-line salvage therapy.

IBD

By Mardi Chapman

28 Feb 2019

The high costs of infliximab in the initial management of steroid-refractory acute severe ulcerative colitis (ASUC) are largely offset with the savings from avoiding hospitalisation and procedure-related costs.

And the equation should only improve in favour of anti-TNF therapy with the growing uptake of biosimilars, a Victorian research team said.

Their study of 118 patients initially managed with either infliximab or colectomy between 2004 and 2014 and followed for a mean of seven years, found inpatient health care utilisation was similar between the two groups.

About 41% of patients initially treated with infliximab required a subsequent colectomy, mostly within the first 12 months of admission with ASUC.

The study found there was no significant difference in the overall number of hospital admissions or the cumulative length of stays based on the initial management.

Early total healthcare costs including inpatient hospitalisation, medications, procedures, and outpatient visits were significantly lower for infliximab patients than colectomy patients at 30 days and through to six months.

“The mean costs increased more rapidly in the infliximab-treated group over long-term follow up, but there were no significant differences from 1 year until 7 years after index admission between patients treated with early infliximab or colectomy (AU$25,406 versus $31,799, p= 0.06 and $72,834 versus $59,557, p=0.23, respectively).”

“This is an important and novel finding, particularly given that almost half of the patients receiving infliximab required maintenance anti-TNF therapy over a long median follow-up period of 7 years, yet even with this long-term anti-TNF use, costs remained comparable with those for early colectomy patients,” they said.

Hospital costs were significantly lower in the first year for patients treated with early infliximab compared with early colectomy ($19,505 v $27,583 at 1 year, p= 0.008), but evened out from two years to seven years (e.g. $44,031 v $45,244, p= 0.85 at seven years).

“In contrast, procedure costs were significantly lower for patients treated with early infliximab compared with early colectomy for all durations to 7 years (cost at 7 years $2598 versus $4097, p= 0.02).”

Complications requiring rehospitalisation were significantly higher amongst patients who received early colectomy versus infliximab (4.0 v 1.0, p< 0.001) and the proportion of patients experiencing complications was significantly higher amongst colectomy first patients (94% v 64%, p= 0.002).

“Medication costs remained significantly higher from 30 days until 7 years after index admission for ASUC for patients treated with early infliximab compared with early colectomy first (mean cost at 7 years $28,202 versus $11,204, p=0.02).”

The researchers, from Eastern Health, said the findings supported the current practice of infliximab as first-line salvage therapy.

“In an era of cost containment and growing concerns for the sustainability of exponentially increasing biologic usage worldwide, this study is the first to our knowledge that shows the consistent, durable reduction in long-term healthcare utilisation achievable with an infliximab-first approach in ASUC.”

“For clinicians, current practice is further confirmed by this study, and reassured by the implication that even in those who still require a subsequent colectomy, infliximab does not appear to increase the risk of postoperative complications requiring hospitalisation.”

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