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P695 Use of infliximab and associated costs in inflammatory bowel disease patients: an analysis of real-life health claims data in the Netherlands

D. Hoekman*1, S. Bots2, M. Benninga1, H. Smeets3, G. D’Haens2, M. Löwenberg2

1Academic Medical Centre (AMC), Department of Paediatric Gastroenterology, Amsterdam, Netherlands, 2Academic Medical Centre (AMC), Department of Gastroenterology, Amsterdam, Netherlands, 3Achmea Health Insurance, Amersfoort, Netherlands

Background

An increasing number of inflammatory bowel disease (IBD) patients is treated with anti-tumour necrosis factor (TNF)-agents, including infliximab (IFX). IFX is often given in non-standard dosing regimens to prevent or overcome loss of response to IFX. Patterns of IFX use have never been described in a large real-life population. The aim of this study was to investigate patterns of IFX use and associated costs in a large real-life population.

Methods

We analysed health insurance claims data of Achmea, the largest health insurance provider in the Netherlands, with a population of approximately 4.3 million insured persons (roughly a quarter of the total Dutch population). Data were collected on health care and medication use in 2012 and 2013 by all IBD patients aged ≥ 18 years. Mean IFX dose was estimated using national average body weight data (CBS Statline).

Results

In the present cohort, 11 753 and 12 443 insured persons received medical care for IBD in 2012 and 2013, respectively. Of these patients, 9% and 10% received at least 1 dose of IFX in 2012 and 2013, respectively. Cohort characteristics are provided in Table 1.

Table 1 Cohort characteristics of patients receiving IFX maintenance treatment at the end of the year

20122013
Receiving IFX maintenance treatment at the end of the year (n,% of IBD patients 
receiving medical care for IBD)802 (7%)905 (7%)
- Crohn’s disease (n, %)607 (76%)656 (72%)
- Age (mean, SD)42.3 (14.6)42.4 (15.1)
- Male gender (n, %)362 (45%)403 (45%)
- Interval: every 4–5 weeks34 (4%)40 (4%)
- Interval: every 6–7 weeks188 (23%)218 (24%)
- Interval: every 8 weeks435 (54%)471 (52%)
- Interval: every 9–10 weeks99 (12%)102 (11%)
- Interval: every 11–12 weeks33 (4%)49 (5%)

When only drug costs are considered, annual costs of IFX treatment in our cohort were €16,382,517 and €18,017,539 in 2012 and 2013, respectively. The 802 and 905 patients who were receiving IFX maintenance therapy at the end of 2012 and 2013, respectively, were further analysed. 54 and 52% of these patients received IFX every 8 weeks in 2012 and 2013, respectively, whereas 28 and 29% of patients received IFX at shorter treatment intervals (ie, < 8 weeks). Roughly 50% of patients were on combination treatment (consisting of IFX and an immunomodulator). The mean IFX dose was 5.4 (SD 1.5) mg/kg body weight. No association was found between IFX treatment interval or dose and diagnosis (ulcerative colitis vs Crohn’s disease; 2012: p = 1.0, p = 0.10; 2013: p = 0.12, p = 0.47), or monotherapy vs combination therapy (2012: p = 0.59, p = 0.74; 2013: p = 0.97, p = 0.08). Gender, however, was associated with IFX dose (2012: mean dose males 5.3 mg/kg, mean dose females 5.6 mg/kg, p = 0.01; 2013: mean dose males 5.3 mg/kg, mean dose females 5.5 mg/kg, p = 0.04), but not with IFX interval (2012: p = 0.23; 2013: p = 0.76).

Conclusion

Approximately 10% of patients in the Netherlands who receive medical care for their IBD are being treated with IFX, and this is associated with significant costs. A substantial proportion of these patients receive non-standard dosing regimens of IFX.