Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease

Abstract

Background. Antitumor necrosis factor (anti-TNF) therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD). Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007-2014) in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations). Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days, P = 0.002). After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45-0.95). After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19-4.43) and ED visits (IRR 2.42; 95% CI: 1.44-4.08) related to IBD. Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD.

Figure 1

Kaplan-Meier curves for time to first dose of anti-TNF therapy stratified type of insurance drug coverage. Publicly funded subjects (solid line) experienced longer times to first anti-TNF dose than privately funded subjects (dashed line).

Figure 2

Rates of hospitalizations and emergency department visits stratified by public versus private drug insurance coverage. Additional sensitivity analyses are performed in which the following groups were excluded (excl): those who received first anti-TNF dose as inpatients (Inpt) or through a compassionate use program (Comp); those with private drug insurance coverage who received supplemental public funding (Copay). All rate differences between private and public drug coverage were statistically significant (^∗P < 0.001).