The direct medical cost of managing IBD patients: A Canadian population based study

Presenter: Teresa Longobardi, University of Manitoba

Abstract

Introduction: The cost of managing IBD in Canada on a per patient basis is unknown. This is important information necessary to adequately assess the value of new therapeutics, namely anti-TNF-α agents. Although the expense of using anti-TNF-α agents may be balanced by a potential reduction in surgical and hospitalization costs there is no population based study that supports the conclusion. This study aims to quantify the direct medical cost of treating IBD in Manitoba in 2005/6 (5 years post infliximab) and will examine the economic impact of infliximab. Methods: IBD subjects of the University of Manitoba IBD Epidemiology Database cases were matched on age, gender and geography to up to 10 non-IBD controls and their data were extracted from Manitoba Health databases for pharmaceutical, physician claims and hospital abstracts. For IBD cases (CD and UC) and controls covered by Manitoba Health in fiscal 2005/6, the average and median expenditure was computed for the annual cost of pharmaceuticals, hospitalizations (outpatient and inpatient) and physician office visits. Age, gender, duration of IBD, type of IBD (CD or UC) year and level of care provided were tested as predictors of costs and the level of costs using a two part model specification. Results: 7375 IBD cases, and 71,682 matched controls were studied. In 2005/6, the average direct cost of an IBD case was $3896. The average cost associated with an IBD case was twice that of controls (p<0.05). There was a significant difference between the average costs for CD and UC cases ($4232; se=137; n=3735 and $3552; se=$117; n=3640 respectively). Also, the average cost of a CD case was significantly greater than that of the average IBD case. Disease duration was associated with cost. The cost of cases with one or more years of disease (90% of cases) was not significantly different from the average IBD case. However, the cost within one year of diagnosis was significantly different from the average IBD case ($6611; se=$593). Expenditure was dependent on the level of care received, excluding patients on prescription medications of immunomodulators or anti-TNF agents, there was no significant difference in the average cost for the remaining 87% of IBD cases when compared to the average overall cost. Patients who had been hospitalized overnight (15%) had an average annual cost of $13,495 (se=$416; max=$130,332). Those that had a surgical stay (2% of IBD cases) had an average annual cost of $18,749 (M=$13,413; max=$125,912). 1.5% of IBD cases used infliximab totaling over $2 million (half the total cost of IBD specific pharmaceuticals). Examining cases who were users of infliximab for the duration of the year (n=49) the average cost was $31,440 (se=$2311; max=$96,328) for both CD and UC cases, although most cases were CD patients. Prior to using infliximab, the estimate of their annual total average cost was $9683 (se=$1745; max=$55,208). Conclusion: Examining medical costs alone, infliximab does not reduce the lifetime cost of care for patients with IBD.