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OP15 Cost analysis in a prospective European population-based inception cohort: is there a cost-saving effect of biological therapy?

J. Burisch*1, H. Vardi2, D. Schwartz3, Z. Krznaric4, P. L. Lakatos5, M. Fumery6, L. Kupcinskas7, F. Magro8, E. Belousova9, P. Oksanen10, N. Arebi11, E. Langholz12, S. Turcan13, R. D’Inca14, V. Hernandez15, D. Valpiani16, Z. Vegh5, M. Giannotta17, K. H. Katsanos18, D. Duricova19, K. R. Nielsen20, H. A. L. Kievit21, P. Ellul22, R. Salupere23, A. Goldis24, I. Kaimakliotis25, N. Pedersen26, V. Andersen27, J. Halfvarson28, S. Sebastian29, J. F. Dahlerup30, P. Munkholm1, S. Odes3, Epi-IBD

1North Zealand University Hospital, Frederikssund, Denmark, 2Ben Gurion University of the Negev, Beer Sheva, Israel, 3Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel, 4University Hospital Center Zagreb, Zagreb, Croatia, 5Semmelweis University, Budapest, Hungary, 6Amiens University and Hospital, Amiens, France, 7Lithuanian University of Health Sciences, Kaunas, Lithuania, 8Hospital de São João, Porto, Portugal, 9Moscow Regional Research Clinical Institute, Moscow, Russian Federation, 10Tampere University Hospital, Tampere, Finland, 11Imperial College London, London, UK, 12Herlev University Hospital, Herlev, Denmark, 13State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova, Republic of, 14Azienda Ospedaliera di Padova, Padova, Italy, 15Complexo Hospitalario Universitario de Vigo, Vigo, Spain, 16Morgagni Hospital, Forli, Italy, 17Careggi Regional Referral Center for Inflammatory Bowel Disease, Florence, Italy, 18University Hospital, Ioannina, Greece, 19Charles University, Prague, Czech Republic, 20National Hospital of the Faroe Islands, Torshavn, Faroe Islands, 21Herning Hospital, Herning, Denmark, 22Mater Dei Hospital, Msida, Malta, 23Tartu University Hospital, Tartu, Estonia, 24University of Medicine ‘Victor Babes’, Timisoara, Romania, 25American Gastroenterology center, Nicosia, Cyprus, 26Slagelse Hospital, Department of medicine, Denmark, 27Regional Hospital of Viborg, Viborg, Denmark, 28Örebro University, Örebro, Sweden, 29Hull and East Yorkshire NHS Trust, Hull, UK, 30Aarhus University Hospital, Aarhus, Denmark

Background

No prospective long-term analysis of healthcare costs in patients with inflammatory bowel disease (IBD) in the era of biological treatments exists in Europe. The aim of this study was to perform a cost analysis of a pan-European inception cohort with 5 years of follow-up.

Methods

The Epi-IBD cohort is a population-based inception cohort of IBD patients diagnosed from 31 centres in 20 European countries in 2010. Data were collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. Data are expressed as mean costs (€/patient-year).

Results

The cohort included 1362 IBD patients (Western Europe: 1,104; Eastern Europe: 258); of which, 52% had ulcerative colitis (UC), 37% Crohn’s disease (CD), and 11% IBD unclassified. Mean total expenditures per patient-year (PY) and the proportion of expenditure spent on different cost categories are shown in Tables 1 and 2. In both Eastern and Western Europe, total annual costs were highest in PY1 and then decreased (Table 1). Expenditure on biological therapy increased in this time period in both Western (PY1 €338, PY2 €410, PY3 €440, PY4 €504, and PY5 €516) and Eastern Europe (PY1 €31, PY2 €233, PY3 €355, PY4 €308, and PY5 €292). In both regions, this was paralleled by a steady decrease of costs of non-biological treatment, hospitalisation, and surgery. In a regression analysis, patients with worse disease phenotype (Figure 1) as well patients aged ≥40 years engendered higher costs. The overall outlay on biological therapy, expressed as a percentage of total expenditure, varied by age group: ≥40 years, 29%; 41–60 years, 21%; and ≥61 years, 11%.

PY1PY2PY3PY4PY5
Total expenditure5579€1820€1714€1907€1669€
Biological therapy (%)1146514855
Other IBD-related medication (%)513111112
Hospitalisation (%)201411116
Diagnostic procedures (%)3417111210
Surgery (%)309161817

Mean total expenditure (€/patient) as well as the proportion of expenditure spent on different categories of direct costs in patients with Crohn’s disease.

PY1PY2PY3PY4PY5
Total expenditure3612€1421€810€983€674€
Biological therapy (%)27201925
Other IBD-related medication (%)1523292126
Hospitalisation (%)3529213317
Diagnostic procedures (%)3820201919
Surgery (%)102110813

Mean total expenditure (€/patient) as well as the proportion of expenditure spent on different categories of direct costs in patients with ulcerative colitis.

Abstract OP015

Distrubition of costs according to phenotype

Conclusion

In this population-based inception cohort of unselected IBD patients, overall direct expenditure on healthcare decreased over a 5-year follow-up period in parallel with remarkably increasing expenditure on biologics, particularly in CD patients, and decreasing expenditure on standard medical treatments, surgery, and hospitalisation. Despite their known high-acquisition charges, these data indicate a cost-saving effect of biological medications.