Burden of Cycling Through Ineffective Treatments and the Impact on Healthcare Resource Utilization: A Real-World Study in Europe
AIBD 2023
Background:
Ineffective Crohn’s disease (CD) treatment can negatively impact disease control, resulting in increased hospitalizations, consultations with healthcare professionals (HCP) and greater cost to the healthcare system. However, patients often continue with prescribed treatment despite not having an optimal response. This study aimed to investigate the healthcare system burden and associated cost of patients cycling through ineffective treatment.
Methods:
Data were drawn from the Adelphi Real World CD Disease Specific Programme™, a cross-sectional survey with retrospective data collection of gastroenterologists and their consulting patients with CD in France, Germany, Italy, Spain, and the United Kingdom between 2020 and 2021. Gastroenterologists reported data on demographics, treatment history, symptom severity, HCP visits, and hospitalization history for their next 5-8 consecutively consulting patients. Patients with physician-reported mild or moderate-severe symptom severity who had been receiving their current treatment for ≥2 months were included in this study. Patients were grouped as either ‘responders’ (those who received only one treatment line and had moderate-severe symptoms upon treatment initiation but mild symptoms at time of survey) or ‘non-responders’ (those who received two or more treatment lines and had moderate-severe symptoms upon initiation and time of survey). Patient demographics and characteristics were compared using t-test and fisher’s exact test. Negative binomial regression models adjusted for disease duration, current treatment, smoking status, and Charlson comorbidity index were used to compare healthcare resource utilization (HCRU) between the groups. Responders were used as the reference category. The associated HCRU costs were reported as adjusted means from log link and gamma family generalized linear model (GLM).
Results:
Data from 464 patients with CD (231 responders, 233 non-responders) were analyzed. Overall, 55.8% of responders and 51.5% of non-responders were male (p=0.35), with a mean (SD) age of 36.1 (12.9) and 40.6 (12.7) years (P< 0.01), respectively. Median (IQR) disease duration was 1.7 (0.8, 2.9) years for responders and 5.0 (2.6, 10.1) years for non-responders. Median (IQR) treatment duration (from first treatment initiation until the time of survey, excluding treatment gaps) was 1.3 (0.7, 2.6) and 3.6 (1.8, 6.7) years respectively. When data was adjusted for time since diagnosis, smoking status and current treatment, non-responders experienced 1.3 times greater number of HCP visits (p=0.01) and 2.3 times greater number of hospitalizations (P< 0.01) in the past 12 months than non-responders. The mean overall cost of HCP visits, hospitalizations, and surgery in the past 12 months was 1.8 times greater for non-responders (2126.11 EUR) compared with responders (1165.31 EUR; P< 0.01).
Conclusions:
Our findings suggest that some patients with CD are cycling through ineffective treatments, culminating in a high burden on the healthcare system and increased costs related to HCRU. This highlights the need for delivering effective interventions at an earlier point in the patient journey to improve disease control, reduce the burden on the healthcare system, and ultimately improve quality of life for patients with CD.
