Biologics, and Costs, Are on the Rise in IBD Treatment, Study Finds

Biologics are increasingly used in the treatment of inflammatory bowel disease (IBD), but real-world data quantifying the costs of these therapies have been lacking. A new study, published in Alimentary Pharmacology and Therapeutics, sought to determine trends in costs and relative market share of IBD therapies in the United States over the past 9 years.

Drawing from de-identified outpatient, inpatient, and pharmaceutical claims for approximately 40 million to 50 million patients in the Truven MarketScan Commercial Claims and Encounters database for the years 2007 to 2015, the researchers included patients with IBD diagnoses and at least 1 pharmaceutical claim during the study period.

The study cohort comprised 415,405 patients; 188,842 patients had Crohn’s disease (CD), 195,183 patients had ulcerative colitis (UC), and 31,380 patients had indeterminate colitis (ID). During the 9-year period, among patients with CD:

• The proportion of patients who used biologics increased from 21.8% to 43.8%
• The proportion of patients who used immunomodulators decreased from 27.2% to 18.0%
• The proportion of patients who used 5-aminosalicylic acid (5-ASA) therapies decreased from 34.1% to 21.6%

In patients with UC:

• The proportion of patients using biologics increased from 5.1% to 16.2%
• Immunomodulator use decreased slightly, from 17.1% to 13.7%
• 5-ASA use also decreased slightly, from 59.0% to 53.7%

Patients who used corticosteroids only remained largely stable in both populations (CD: 16.9% versus 16.6%; UC: 18.8% versus 16.2%).

Utilization trends show a consistent rise in biologics’ market share; from 2007 to 2015, use of biologic therapies increased from 13.7% to 30.1%. A pediatric subgroup analysis showed an even sharper rise in biologics use, from 19.1% in 2007 to 45.9% in 2015.

The cost of biologic therapy also rose over the study period; in 2007, the average patient taking biologic therapy accounted for $25,275 in per-member per-year costs (a value comprising the costs paid by a patient's health plan plus the patients’ copay and deductible amounts). In 2015, that amount rose to $36,051. Pediatric patients’ costs grew even more, from an average $23,616 to $41,109. These cost trends for biologics “greatly exceed” the cost trends for other drugs that treat IBD, including immunomodulators, 5-ASAs, or corticosteroids.

“From a clinician perspective, corticosteroid-sparing therapy plans are evidence-based and necessary to optimize long-term health outcomes, maximize quality of life, and minimize opportunity loss,” the authors write. However, the increases in cost associated with biologic therapies are only expected to continue for US patients with IBD. “The findings from our study further reiterate the ongoing need to develop patient-centered, cost-effective pharmacotherapy strategies by judiciously incorporating biologics in individualized therapy plans.