Treatment Patterns and Economic Burden of Ulcerative Colitis in Japan: A Retrospective Claims Analysis

Abstract

Introduction: This retrospective claims analysis characterized contemporary ulcerative colitis (UC) treatment patterns and investigated the economic burden of UC in Japan.

Methods: This study used anonymized claims data in the Medical Data Vision database. Patients were included if they had a confirmed UC diagnosis and ≥ 1 claim of systemic treatment for UC (index date) between June 2018 and December 2022, in addition to continuous enrollment for ≥ 6 months before and ≥ 12 months after the index date. Patients were excluded if they were aged < 18 years at index or if they had claimed systemic UC treatment during the pre-index period, had a confirmed diagnosis of Crohn's or Behçet's disease, or had a record of colectomy during the pre-index period. Outcomes of interest were treatment patterns, healthcare resource utilization (HCRU), and UC-related costs per person per month (PPPM). Further exploratory analyses were conducted to understand whether real-world treatment patterns with conventional therapy were optimally aligned with guideline recommendations. Two definitions of suboptimal treatment with conventional therapies were identified: prolonged treatment with corticosteroids (i.e., consecutive use for > 90 days) and corticosteroid cycling (i.e., three or more ≥ 30-day corticosteroid courses over 1 year, with a ≥ 60-day gap between courses).

Results: Overall, 15,429 patients were included. The most frequently observed class of first-line treatment was 5-aminosalicylic acid monotherapy (75.0%); treatment modification was observed in 39.7% of patients. Within 1 year of follow-up, patients had a mean (SD) of 9.8 (6.8) outpatient visits, and a hospital stay was reported in 23.9% of patients. Mean total cost PPPM was ¥76,374. Of patients with ≥ 1 course of corticosteroids, 39.8% received suboptimal treatment with conventional therapies. HCRU and total costs were higher for patients with versus without suboptimal treatment with conventional therapies.

Conclusions: Japanese patients with UC would benefit from treatment options that can reduce costs, HCRU, and suboptimal treatment with conventional therapies.

Keywords: Claims analysis; Corticosteroid; Health care costs; Inflammatory bowel disease; Japan; Observational study; Ulcerative colitis.

Fig. 1

Patient attrition. MDV Medical Data Vision; UC ulcerative colitis

Fig. 2

Treatment patterns across four lines of therapy. ^aPatients discontinued treatment or continued treatment with no additional modifications until the end of the study period. 1L first line; 2L second line; 3L third line; 4L fourth line; 5-ASA 5-aminosalicylic acid; IL interleukin; JAK Janus kinase; NA not applicable; TNF tumor necrosis factor

Fig. 3

Treatment patterns over three lines of therapy. Line 1 implies patients moving from first- to second-line treatment; line 2 implies patients moving from second- to third-line treatment; and line 3 implies patients moving from third- to fourth-line treatment. ^aPatients were censored if they continued their treatment with no modifications for the remainder of the study period