Resource use and cost of care with biologicals in Crohn’s disease in South Africa: a retrospective analysis from a payer perspective

Abstract

Background Crohn's disease is a relapsing remitting inflammatory disease of the gastrointestinal tract. Treatment may require expensive biological therapy in severe patients. Affordability of the high cost anti-TNF-α agents has raised concern although evidence suggests cost-offsets can be achieved. There is little information on the resource utilisation of Crohn's patients in low and middle income countries. Objective The objective of this study is to investigate the resource utilisation and costs associated with biologicals treatment of Crohn's disease. Setting The setting for this study is in private healthcare in South Africa from a payer perspective. Method A retrospective longitudinal analysis of an administrative claims database from a large private healthcare insurer of patients who had at least 1 year claims exposure prior to starting biologicals and 2 years follow-up thereafter. Resource utilisation and costs including total Crohn's costs, hospital admissions and surgery, out of hospital costs, biologicals and chronic medicines were analysed. Main outcome measure The primary objective was to compare the change in resource utilisation and costs for Crohn's related conditions before and after starting biological treatment. Results A cohort of 72 patients was identified with a 35% (p = 0.005) reduction in Crohn's related costs (excluding the cost of biologicals) from ZAR 55,925 (U$5369) 1 year before compared to ZAR 36,293 (U$3484) 2 years after starting biological medicines. However, inclusion of the cost of biologicals more than doubled the total costs to ZAR 150,915 (±91,642) U$14,488 (±8798) in Year 2. Significant reductions in out-of hospital Crohn's related spend was also observed. Conclusions A reduction in healthcare costs is seen following starting biologicals in patients with moderate to severe Crohn's disease. However, the high cost of biological therapy outweighs any possible savings achieved in other areas of healthcare utilisation.

Evaluation of economic burden with biologic treatments in Crohn’s disease patients: A mirror image study using an insurance database in Japan

“…However, biologic initiation was associated with an increase in pharmacy costs by 40% and total costs by 6%. Similarly, other studies in various healthcare systems have associated biologic initiation with a reduction in inpatient and outpatient visits and their associated costs; however, an increase in pharmacy costs, most likely due to biologic prescriptions, resulted in greater total direct costs compared with pre-biologic expenses [30][31][32]. Although the present study did not distinguish between biologic and other drug-related costs, Saito et al [18] analyzed patient data (2013-2016) from the JMDC database and reported the total CDrelated costs to be ¥7,139,604,830, with anti-TNFα agents accounting for 59.5% of the total…”

Efficacy and safety of Tripterygium wilfordii Hook F preparations for the treatment of Crohn disease

“…[3] Data from a variety of studies indicates that CD is associated with substantial direct and in-direct costs across patients’ lifespan. [4,5] Symptoms of active CD, such as diarrhea and abdominal pain, have been shown to impact health related quality of life substantially in large multinational studies. [6,7]…”