title: Resources Utilization and Costs the Year Before and After Starting Treatment with Adalimumab in Crohn's Disease Patients.
abstract: BACKGROUND
  This study examines the resources utilization in patients with Crohn's disease (CD) during the year before (Y - 1) and after (Y + 1) starting treatment with adalimumab and the drug's efficiency.
  
  
  METHODS
  Observational, multicenter, prospective cohort study of patients with CD naive to biological drugs. The proportion of patients with CD Activity Index (CDAI) <150 was considered as the effectiveness variable. Costs considered were direct costs (DC) related to the use of health care resources, and indirect costs (IC) related to sick leave in Y - 1 and Y + 1. Adalimumab efficiency was estimated as the incremental cost/effectiveness ratio. A deterministic sensitivity analysis was performed building 3 scenarios: base case, the least favorable, and the most favorable case for adalimumab.
  
  
  RESULTS
  In the cohort of 126 patients (50.8% men; age 39.1 ± 13.8 yr), the proportion of patients in remission increased from 34.1% by the end of Y - 1 to 83.3% by the end of Y + 1. Although the DC increase by the use of adalimumab, the use of doctor visits, emergency room visits, laboratory tests, diagnostic examinations, and nonbiological drug treatment were lower (P < 0.05) in Y + 1 than Y - 1. In the base case scenario, considering only DC, the incremental cost/effectiveness ratio was €31,308 and including IC, it was €28,936. In patients with CDAI > 150 at the onset, incremental cost/effectiveness ratio was €20,119 and €18,223, considering DC alone or included IC, respectively.
  
  
  CONCLUSIONS
  In patients with CD, adalimumab increases pharmacological costs at the expense of biological therapy but reduces the cost of other drugs, the use of health care resources, and IC. Adalimumab efficiency is 30% greater in patients with CDAI > 150.
authors.affiliation: *Gastroenterology Service, Hospital de Cabueñes, Gijón, Spain; †Gastroenterology Service, Hospital Dr. Negrín, Las Palmas, Spain; ‡Gastroenterology Service, Complejo Asistencial Universitario de León, León, Spain; §Research Department, Advanced Techniques for Health Services Research, Madrid, Spain; ‖Digestive System Service, Hospital Universitario Reina Sofía, Córdoba, Spain; ¶Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain; **Gastroenterology Service, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; ††Gastroenterology Service, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain; ‡‡Gastroenterology Service, Hospital Universitario Río Hortega, Valladolid, Spain; §§Gastroenterology Department, University Central Hospital of Asturias, Oviedo, Spain; and ‖‖Gastroenterology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Saro
authors.forename: Daniel
authors.initials: D
authors.lastname: Ceballos
authors.forename: Fernando
authors.initials: F
authors.lastname: Muñoz
authors.forename: Cristóbal
authors.initials: C
authors.lastname: De la Coba
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Aguilar
authors.forename: Pablo
authors.initials: P
authors.lastname: Lázaro
authors.forename: Eva
authors.initials: E
authors.lastname: Iglesias-Flores
authors.forename: Manuel
authors.initials: M
authors.lastname: Barreiro-de Acosta
authors.forename: María-Dolores
authors.initials: MD
authors.lastname: Hernández-Durán
authors.forename: Jesús
authors.initials: J
authors.lastname: Barrio
authors.forename: Sabino
authors.initials: S
authors.lastname: Riestra
authors.forename: Luis
authors.initials: L
authors.lastname: Fernández Salazar
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000188:drug therapy* / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012074:Remission Induction
chemical_list: D000893:Anti-Inflammatory Agents; D000068879:Adalimumab