Treatment sequencing patterns and healthcare resource utilization in patients with Crohn's disease initiating biologics: a 3-year retrospective claims-based analysis
- PMID: 41158060
- DOI: 10.1080/03007995.2025.2581397
Treatment sequencing patterns and healthcare resource utilization in patients with Crohn's disease initiating biologics: a 3-year retrospective claims-based analysis
Abstract
Objective: This study aimed to provide a comprehensive analysis of long-term treatment patterns, biologic treatment sequencing, healthcare resource utilization (HCRU), and costs in biologic-naïve patients with CD.
Methods: This retrospective analysis utilized data from the IQVIA PharMetrics Plus claims database (2014-2022), representative of the United States (US) commercially insured population under 65 years. Biologic-naïve adults (≥18 years) with CD were included if they had ≥12 months of continuous enrollment before and after initiating Food and Drug Administration (FDA)-approved biologics (2015-2021). Outcomes included treatment persistence, switching, dose escalation, augmentation, and HCRU over 12-36 months of follow-up. Dose escalation and augmentation were defined based on therapy adjustments or concurrent use of conventional treatments. Descriptive and Kaplan-Meier analyses were conducted using SAS 9.4 to evaluate treatment patterns and outcomes.
Results: Of 390,396 patients with a qualifying claim during the index period, 7,353 biologic-naïve patients with CD met the inclusion criteria. The cohort had a mean age of 39.2 (standard deviation [SD] = 13.8) years, 51.4% were female, and 97.2% had commercial insurance. Follow-up averaged 32.5 (SD = 17.2) months, with 59.5% having ≥24 months of follow-up. Adalimumab (50.6%) and infliximab (26.9%) were the most common first-line therapies. Ustekinumab as first-line therapy showed numerically highest persistence (12 months: 79.0%; 24 months: 69.9%) and highest dose escalation rates among biologics. Median time to augmentation was 1.5 months for first-line therapies. Total CD-related costs per year varied across therapy groups, with ustekinumab having the numerically highest costs ($135,311 [SD = 69,162]).
Conclusion: This analysis reveals variability in biologic treatment patterns. Most biologic-naïve patients start with anti-TNFs, even though other therapies show numerically higher persistence than anti-TNFs, highlighting the need for effective treatment sequencing and monitoring. Rising healthcare costs emphasize strategic decisions for effective biologics and efficient resource allocation in real-world settings.
Keywords: Crohn’s disease; Persistence; biologics sequencing; healthcare resource utilization; tumor necrosis factor inhibitors.
Plain language summary
This study looked at how people with Crohn’s disease (CD) in the United States use biologic medicines over time. We analyzed health insurance claims from over 7,000 adults who were starting biologic treatment for the first time. We found that most patients began with older biologics called anti-TNF drugs, but newer options like ustekinumab and vedolizumab were used more often after one or two biologics. People who used newer options like ustekinumab tended to stay on them longer and needed higher doses. Hospital visits and healthcare costs increased as patients moved from the first to the third treatments. The findings suggest that choosing the right first treatment is important and may have an impact on future health and costs.
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous
