Skip to main content

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

International Journal of Clinical Pharmacy volume 38, pages 880–887 (2016)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Baumgart D, Sandborn W. Crohn’s disease. Lancet. 2012;380(9853):1590–605.

    Article  PubMed  Google Scholar 

  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.

  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.

    Article  Google Scholar 

  4. Amiot A, Peyrin-Biroulet L. Current, new and future biological agents on the horizon for the treatment of inflammatory bowel diseases. Ther Adv Gastroenterol. 2015;8(2):66–82.

    Article  Google 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.

  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.

  7. Park K, Bass D. Inflammatory bowel disease—attributable costs and cost-effective strategies in the United States: a review. Inflamm Bowel Dis. 2011;17:1603–9.

    CAS  Article  PubMed  Google Scholar 

  8. Tang D, Harrington A, Lee J, Lin M, Armstrong E. A systematic review of economic studies on biological agents used to treat crohn’s disease. Inflamm Bowel Dis. 2013;19(12):2673–94.

    Article  PubMed  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.

  10. van der Valk M, Mangen M-J, Leenders M, Dijkstra G, van Bodegraven A, Fidder H, et al. Healthcare costs of inflammatory bowel disease have shifted from hospitalisation and surgery towards anti-TNFα therapy: results from the COIN study. Gut. 2014;63:72–9.

    Article  PubMed  Google Scholar 

  11. Vester-Andersen M, Prosberg M, Jess T, Andersson M, Bengtsson B, Blixit T, et al. Disease course and surgery rates in inflammatory bowel disease: a population based, 7-year follow-up study in the era of immunomodulating therapy. Am J Gasteroenterol. 2014;109:705–14.

    Article  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.

    Article  PubMed  Google Scholar 

  13. Bernstein C, Loftus E Jr, Ng S, Lakatos P, Moum B. Epidemiology and natural history task force of the international organization for the study of inflammatory bowel disease (IOIBD). Hospitalisations and surgery in Crohn’s disease. Gut. 2012;61(4):622–9.

    Article  PubMed  Google Scholar 

  14. O’Keefe E, Wright J, Froggatt J, Zabow D. Medium-term follow-up of Crohn’s disease in Cape Town. S Afr Med J. 1989;76(4):139–41.

    PubMed  Google Scholar 

  15. Goldberg P, Wright J, Gerber M, Claassen R. Incidence of surgical resection for Crohn’s disease. Dis Colon Rectum. 1993;36(8):736–9.

    CAS  Article  PubMed  Google Scholar 

  16. Basson A, Swart R, Jordaan E, Mazinu M, Watermeyer G. The association between race and Crohn’s disease phenotype in the Western Cape population of South Africa, defined the by the Montreal classification system. PLoS One. 2014;9(8):e104859.

    Article  PubMed  PubMed Central  Google 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.

  19. Loomes D, Teshima C, Jacobs P, Fedorack R. Health care resource use and costs for Crohn’s disease before and after infliximab therapy. Can J Gastroenterol. 2011;25(9):497–502.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lichtenstein G, Yan S, Bala M, Blank M, Sands B. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology. 2005;128(4):862–9.

    CAS  Article  PubMed  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  22. Sprakes M, Ford A, Suares N, Warren L, Greer D, Donnellan C, et al. Costs of care for Crohn’s disease following the introduction of infliximab: a single-centre UK experience. Aliment Pharmacol Ther. 2010;32:1357–63.

    CAS  Article  PubMed  Google Scholar 

  23. Nugent Z, Blanchard J, Bernstein C. A population-based study of health-care resource use among infliximab users. Am J Gastoenterol. 2010;105:2009–16.

    Article  Google Scholar 

  24. Sulz M, Siebert U, Arvandi M, Gothe R, Wurm J, von Kanel R, et al. Predictors for hospitalisation and outpatient visits in patients with inflammatory bowel disease: results from the Swiss Inflammatory Bowel Disease Cohort Study. Eur J Gasteroenterol Hepatol. 2013;25:790–7.

    CAS  Article  Google Scholar 

  25. Taxonera C, Rodgrigo L, Casellas F, Calvet X, Gomez-Camacho F, Ginard D, et al. Infliximab maintenance therapy is associated with decreases in direct resource use in patients with luminal or fistulising Crohn’s disease. J Clin Gastroenterol. 2009;43(10):950–6.

    CAS  Article  PubMed  Google Scholar 

  26. Carter C, Waters H, Smith D. Impact of infliximab adherence on Crohn’s disease related healthcare utilisation and inpatient costs. Adv Ther. 2011;28(8):671–83.

    CAS  Article  PubMed  Google Scholar 

  27. Kane S, Chao J, Mulani P. Adherence to infliximab maintenance therapy and healthcare utilisation and costs by Crohn’s disease patients. Adv Ther. 2009;26(10):936–46.

    CAS  Article  PubMed  Google Scholar 

  28. D’Inca R, Caccaro R. Measuring disease activity in Crohn’s disease: what is currently available to the clinician. Clin Exp Gastroenterol. 2014;7:151–61.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Levesque B, Sandborn W, Ruel J, Feagan B, Sands B, Colombel J-F. Converging goals of treatment of inflammatory bowel disease from clinical trials and practive. Gastroenterology. 2015;148:37–51.

    Article  PubMed  Google Scholar 

  30. Epstein D, Watermeyer G, Kirsch R. Review article: the diagnosis and management of Crohn’s disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther. 2007;25:1373–88.

    CAS  Article  PubMed  Google Scholar 

  31. Deetlefs E, Epstein D, Watermeyer G, Seggie R, Thomson S. Tuberculosis in an inflammatory bowel disease cohort from South Africa. S Afr Med J. 2012;102(10):802–4.

    CAS  Article  PubMed  Google Scholar 

  32. Sussman D, Kubiliun N, Mulani P, Chao J, Gillis C, Yang M, et al. Comparison of medical costs among patients using adalimumab and infliximab: a retrospective study (COMPAIRS). Inflamm Bowel Dis. 2012;18(11):2043–55.

    Article  PubMed  Google Scholar 

  33. Esposti L, Sangiorgi D, Perrone V, Radice S, Clementi E, Perone F, et al. Adherence and resource use among patients treated with biological drugs: findings from BEETLE Study. Clinicoeco Outcomes Res. 2014;6:401–7.

    Article  Google Scholar 

Download references

Acknowledgments

Acknowledgments go to Rose Moore who assisted with the data analysis and Noluthando Nematswerani who reviewed the final article.

Funding

No external funding was provided for this study.

Author information

Affiliations

  1. Department of Pharmacy and Pharmacology, Faculty of Health Sciences, School of Therapeutic Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2196, South Africa

    Jacqui Miot

  2. Clinical Policy Unit, Discovery Health, Sandton, South Africa

    Jacqui Miot, Susan Smith & Niri Bhimsan

Authors
  1. Jacqui Miot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Niri Bhimsan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacqui Miot.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Miot, J., Smith, S. & Bhimsan, N. Resource use and cost of care with biologicals in Crohn’s disease in South Africa: a retrospective analysis from a payer perspective. Int J Clin Pharm 38, 880–887 (2016). https://doi.org/10.1007/s11096-016-0304-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-016-0304-7

Keywords

  • Biologicals
  • Clinical pharmacology
  • Cost
  • Crohn’s disease
  • Pharmacoeconomics
  • South Africa