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P070. Economic impact of deep remission in adalimumab-treated patients with Crohn's disease: Results from EXTEND

J. Colombel1, W.J. Sandborn2, E. Louis3, R. Panaccione4, M. Yang5, J. Chao5, P.M. Mulani5

1Centre Hospitalier Universitaire de Lille, Lille, France; 2University of California, San Diego, La Jolla, CA, United States; 3University of Liège, Liège, Belgium; 4University of Calgary, Calgary, AB, Canada; 5Abbott Laboratories, Abbott Park, IL, United States

Aim: To demonstrate the economic benefit of deep remission in adalimumab-treated patients with Crohn's disease (CD).

Materials and Methods: EXTEND was a randomized, placebo-controlled study of patients with moderate to severe ileocolonic CD (CDAI 220–450). Patients received open-label adalimumab 160-/80-mg induction therapy at Weeks 0/2 and were randomized at Week 4 to maintenance therapy with adalimumab 40 mg every other week (eow) or placebo through Week 52. Early deep remission was defined as observed mucosal healing and clinical remission (CDAI < 150) at Week 12. The current analysis evaluated the relationship between Week-12 deep remission status and health care costs over the next 40 weeks for adalimumab-treated patients. Outcomes included hospitalization costs (number of hospitalizations at a fixed cost of $36,159 per hospitalization [1]), direct non-hospitalization medical costs (calculated using fixed biweekly costs of $277, $506, and $580 for remission [CDAI < 150], moderate CD [150 ≤ CDAI < 300], and severe CD [300 ≤ CDAI < 450], respectively [2]), and indirect costs (cost of overall work impairment caused by CD [assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI)] based on a fixed biweekly median salary of $1,496 [3]). Last-observation-carried-forward imputation was used to assess CDAI and WPAI missing values. The 95% confidence interval (CI) of each cost was evaluated using a Monte Carlo simulation based on the data.

Results: A total of 64 patients randomized to adalimumab 40 mg eow receiving adalimumab at Week 12 were included in the analysis. The total direct costs, including hospitalization costs and non-hospitalization medical costs through Week 52 were $5,735 for patients who achieved deep remission and $11,404 for non-achievers, representing a significant incremental cost savings of $5,669 (95% CI: $3,324, $8,957) (table). The total indirect costs were significantly less for patients who achieved deep remission than for non-achievers, with a cost savings of $4,243 (95% CI: $2,871, $5,477) (table). With achievement of deep remission, the total cost savings over 40 weeks were $9,912 (95% CI: $7,251, $13,576) (table).

Health care costs over 40 weeks for patients who did and did not achieve deep remission at Week 12
Week-52 Costs (US $ 2009)Deep Remission Achievers (N = 11)Deep Remission Non-Achievers (N = 53)Difference
Total direct costs5,73511,404−5,669
Direct non-hospitalization costs5,7357,992−2,257
Hospitalization costs03,411−3,411
Total indirect costs8,95813,201−4,243
Total costs (direct+indirect)14,69324,604−9,912

Conclusion: Adalimumab-treated patients who achieved deep remission at Week 12 had health care costs savings of about $9,900 at 1 year vs. those who did not achieve deep remission.

1. Cohen RD et al. Am J Gastroenterol. 2000;95:524–30.

2. Feagan BG et al. Am J Gastroenterol. 2000;95:1955–60.

3. US Bureau of Labor Statistics. Accessed April 1, 2010.