Background : The majority of patients with Crohn’s Disease (CD) will be hospitalized and receive surgery for their disease. Hospitalizations and surgical procedures account for the majority of the direct costs of CD.
Purpose : Our objective was to use population-based administrative data from the province of Quebec, Canada, to estimate the effectiveness of infliximab therapy in reducing CD-related surgery, hospitalization and health care resource consumption in subjects with CD.
Methods : We obtained patient level prescription data, physician billing claims and hospitalization data from the Régie de l'Assurance Maladie du Québec (RAMQ) a Canadian provincial health care provider. Subjects who were enrolled in the system for a minimum of two years and who received prescription drug benefits for each year they participated in the study were identified as being affected by CD using a validated algorithm. For each subject treated with infliximab, up to two closely matched comparison subjects were selected using propensity score methods. We compared time to first CD-related intra-abdominal surgery and hospitalization as well as total hospitalized days and physician visits between infliximab users and non-users.
Results : We were able to match 319 (77%) out of the 414 infliximab users to comparison subjects using propensity score matching; 300 were matched to two infliximab non-users and 19 were matched to one non-user to create 619 matched-pair sets. Subjects who received infliximab therapy had a significantly reduced risk of experiencing a CD-related intra-abdominal surgery (HR=0.674, 95%CI 0.533-0.853, p=0.001), any hospitalization (HR=0.753, 95%CI 0.619-0.917 p=0.005), and CD-related hospitalization (HR=0.726, 95%CI 0.565-0.934 p=0.013). Infliximab users experienced lower rates of hospitalized days (RateR=0.6418, 95%CI 0.4399-0.9362; P=0.021) and gastroenterologist visits (RateR=0.810, 95% CI 0.700-0.937; P=0.005). Infliximab users and non-users had similar rates of non-gastroenterologist physician visits (RateR=0.928, 95% CI 0.851-1.057; P=0.262).
Conclusion : Infliximab therapy was associated with significant reductions in CD-related intra-abdominal surgeries, hospitalizations, hospitalized days and gastroenterologist visits. Our results confirm the population-based effectiveness of infliximab beyond the ideal conditions of clinical trials.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:OTU.1807/24314 |
| Date | 13 April 2010 |
| Creators | Leombruno, John Paul |
| Contributors | Einarson, Thomas Ray |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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