Resource use and cost of care with biologicals in Crohn’s disease in South Africa: a retrospective analysis from a payer perspective
- 202 Downloads
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.
KeywordsBiologicals Clinical pharmacology Cost Crohn’s disease Pharmacoeconomics South Africa
Acknowledgments go to Rose Moore who assisted with the data analysis and Noluthando Nematswerani who reviewed the final article.
No external funding was provided for this study.
Conflict of interest
J.M. has carried out educational training for Novartis and serves as a consultant for Discovery Health. N.B. and S.S. declare no conflict of interest.
- 2.NICE clinical guidance, 152. Crohn’s disease: management in adults, young people and children. s.l.: NICE (National Institute for Health and Care Excellence); 2012. guidance.nice.org.uk/cg152.Google Scholar
- 3.Terdiman J, Gruss C, Heidelbaugh J, Sultan S, Falck-Ytter Y, The AGA Institute Clinical Practice and Quality Management Committee. American Gasteroenterological Association Institute guideline on the use of thiopurines, methotrexate, and anti-TNF—a biological drugs for the induction and maintenance of remission in inflammatory crohn’s disease. Gasteroenterology. 2013;145:1459–63.CrossRefGoogle Scholar
- 5.NICE technology appraisal guidance, 187. Infliximab (review) and adalimumab for the treatment of Crohn’s disease. NICE (National Institute of Health and Care Excellence); 2010. guidance.nice.org.uk/ta187.Google Scholar
- 6.SAGES Clinical Guideline Committee. SAGES clinical guidelines. Anti-tumour necrosis factor antibodies (Anti-TNF) in inflammatory bowel disease. SA Gastroenterol Rev. 2009;7(2):19–20.Google Scholar
- 9.Dretzke J, Edlin R, Round J, Connock M, Hulme C, Czeczot J, et al. A systematic review and economic evaluation of the use of tumour necrosis factor-alpha (TNF-a) inhibitors, adalimumab and infliximab, for Crohn’s disease. Health Technol Assess. 2011; 15(6):1–244.Google Scholar
- 12.Burisch J, Vardi H, Pedersen N, Brinar M, Cukovic-Cavka S, Kaimakliotis I, et al. Costs and resource utilization for diagnosis and treatment during the initial year in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom Study. Inflamm Bowel Dis. 2015;21(1):121–31.CrossRefPubMedGoogle Scholar
- 17.Annual Report Council for Medical Schemes 2013/14. South African council for medical schemes; 2014. www.medicalschemes.com. ISBN: 978-0-620-60270-9.
- 18.Selected Historical Rates [Internet]. South African Reserve Bank [date unknown] [Cited 07 March 2016]. https://www.resbank.co.za/research/rates/pages/selectedhistoricalexchangeandinterestrates.aspx.
- 21.Lindsay J, Chipperfield R, Giles A, Wheeler C, Orchid T. On behalf of the INDIGO study investigators. A UK retrospective observational study of clinical outcomes and healthcare resource utilisation of infliximab treatment in Crohn’s disease. Aliment Pharmacol Ther. 2013;38:52–61.CrossRefPubMedGoogle Scholar