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P320 Clinical and economic effect of short infliximab infusion protocol in patients with inflammatory bowel diseases: a multicentre study

M. Cappello*1, G. Costantino2, A.C. Privitera3, F. Bossa4, A. Lauria5, L. Grossi6, M. B. Principi7, N. Della Valle8, M. A. Veneziano9, D. Crocchiolo9

1University of Palermo, Gastroenterology Section, DiBiMis, Palermo, Italy, 2Università di Messina, Dipartimento di Medicina Interna e Terapia Medica, Messina, Italy, 3Azienda Ospedaliera per l’Emergenza, Ospedale Cannizzaro, Catania, Gastroenterologia, Catania, Italy, 4Casa Sollievo della Sofferenza, Gastroenterologia, S. Giovanni Rotondo, Foggia, Italy, 5A. O. Bianchi-Melacrino-Morelli, Reggio Calabria, Gastroenterologia e Endoscopia Digestiva, Reggio Calabria, Italy, 6Ospedale Spirito Santo, Pescara, Fisiopatologia Digestiva, Pescara, Italy, 7Policlinico, Department of Gastroenterology, Bari, Italy, 8Ospedale di Foggia, Gastroenterologia, Foggia, Italy, 9MSD Italy, Rome, Italy

Background

Infliximab (IFX) is a monoclonal antibody anti-TNF used in the treatment of IBD usually administered IV at a dose of 5 mg/kg as a 2-hour infusion. We have previously demonstrated that shortening the infusion protocol to 1 hour is equally safe. Our aim was to assess the effect of short IFX infusion on hospital resource utilisation and costs.

Methods

All IBD patients who received IFX 1 h infusion from March 2007 to September 2014 in 8 centres from Southern Italy were included in the analysis. Demographic, clinical, and infusion-related data were collected. The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity. In addition, indirect patient-related cost savings were evaluated.

Results

In total, 125 patients were included (64 with ulcerative colitis and 61 with Crohn’s disease). Median duration of disease was of 53 months and mean age of pts at diagnosis was of 34 years (SD: ± 13). Adverse infusion reactions were reported in less than 4% both before and after short infusion. The total number of infusions across the selected centres was of 2 501 (30.5% short infusions). In the analysed cohort, 1 143 hours were saved (762 in the infusion and 381 in observation phases) through the rapid IFX infusion protocol. This time saving (-15% compared with traditional protocol in infusion phase) represents, from the hospital perspective, an opportunity to optimise infusion unit capacity by allocating the saved time in alternative cost-effective treatments. This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use. Hence, an extra hour of infusion in the case of traditional 2-h IFX represents a loss in opportunity to provide other cost-effective services. The analysis showed that the short infusion increased the infusion units-capacity up to 50% on days when the IFX infusions were scheduled (infusion phase). Further, the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase (observation) by leading to a time saving of 10% on average amongst the analysed centres. Finally, the short infusion protocol has been demonstrated to lead to indirect cost savings of €114/patient (average -€14.290 on the whole cohort).

Conclusion

A short IFX infusion protocol can be considered time and cost saving in comparison with the traditional infusion protocol because it contributes to increase infusion-units capacity up to 50%. From the patients’ perspective, it reduces indirect costs and the effects of treatment on everyday life and work productivity.