title: Health care resource use and costs in Crohn's disease before and after infliximab therapy.
abstract: BACKGROUND
  Infliximab therapy in patients with Crohn's disease decreases resource use; however, the overall impact on health-related expenditures is unclear, especially beyond one year of study.
  
  
  METHODS
  A retrospective analysis of economic data one and two years before and after infliximab therapy was performed using patients who served as their own controls. Total health care resource use and direct health care costs were compared for patients with or without fistulae.
  
  
  RESULTS
  Patients with one (n=66) and two (n=39) years of economic data before and after infliximab treatment had their resource use and direct health care costs estimated. In the year following initiation of infliximab therapy, there were significant decreases in health care use, reflected in total hospital days (495 to 155 [P<0.05]), inpatient colonoscopies (46 to 24 [P<0.05]), outpatient colonoscopies (58 to 33 [P<0.05]) and major surgeries (10 to 2 [P<0.05]). Direct health care costs of inpatient costs for luminal (-$1,747 [P<0.05]) and fistulizing disease (-$2,530 [P<0.05]), major surgeries (-$1240 [P<0.05]) and outpatient colonoscopies (-$184 [P<0.05]) were also significantly reduced before and after infliximab therapy. Total direct health care costs, including the drug cost of infliximab, increased ($21,416 [P<0.05]). In general, the trends in health care costs analyzed over four consecutive years paralleled the two consecutive-year analysis.&nbsp;
  
  
  CONCLUSIONS
  Infliximab therapy in patients with Crohn's disease resulted in a significant decrease in both resource use and health care costs, but an increase in total direct health care costs once the cost of infliximab was added.
authors.affiliation: Division of GAstroenterology, University of Alberta, Edmonton, Alberta. dloomes@ualberta.ca
authors.forename: Dustin E
authors.initials: DE
authors.lastname: Loomes
authors.forename: Christopher
authors.initials: C
authors.lastname: Teshima
authors.forename: Philip
authors.initials: P
authors.lastname: Jacobs
authors.forename: Richard N
authors.initials: RN
authors.lastname: Fedorak
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000893:Anti-Inflammatory Agents / Q000191:economics* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D003424:Crohn Disease / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D000069285:Infliximab; D007412:Intestinal Fistula / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab