Infliximab use in Crohn's disease: impact on health care resources in the UK.
OBJECTIVE
To quantify the impact of infliximab therapy on health care resource utilization in the UK.


METHODS
A retrospective audit was undertaken at seven centres in the UK, which reviewed patient notes for a period of 6 months before and 6 months after an initial infliximab infusion. Details of hospital admissions, outpatient visits, operations, diagnostic procedures, drug usage, and overall efficacy were collected. Results were compared for the two 6 month study periods.


RESULTS
A total of 205 patients (62% female, median age 33 years) with moderate/severe Crohn's disease were audited. The majority of patients had chronic active disease (62%) and most received one infusion initially (72%). Clinicians rated 74% of responses as good to excellent and patients 72%. Most patients had concomitant immunosuppression (pre: 75%, post: 75%). Approximately half of the patients (45%) stopped taking steroids, with a further 34% having a dosage reduction. A fall of 1093 inpatient days was seen (1435 vs. 342) in the 6 months following infliximab administration. There were seven fewer operations, 33 fewer examinations under anaesthetic, and 99 fewer diagnostic procedures. Outpatient visits were similar pre- versus post- (555 vs. 534). The total reduction in direct costs amounted to an estimated pounds 591,006. Three hundred and fifty-three infliximab infusions were administered at an estimated cost of pounds 562,719. Thus, there was a net reduction of pounds 28,287 or pounds 137.98 per patient.


CONCLUSIONS
Infliximab appears to be a potentially cost effective treatment for selected patients based on the reduced number of inpatient stays, examinations under anaesthetic, and diagnostic procedures over a 6 month period.
Jewell
Derek P
DP
Gastroenterology Unit, University of Oxford, Sheffield, UK. Derek.jewell@ndm.ox.ac.uk
Satsangi
Jack
J
Lobo
Alan
A
Probert
Christopher
C
Forbes
Alastair
A
Ghosh
Subrata
S
Shaffer
Jon
J
Frenz
Markus
M
Drummond
Hazel
H
Troy
Gill
G
Turner
Sue
S
Younge
Lisa
L
Evans
Lyn
L
Moosa
Mark
M
Rodgers-Gray
Barry
B
Buchan
Scot
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000188:drug therapy* / Q000191:economics / Q000601:surgery; D016527:Drug Costs / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D006113:United Kingdom
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab