A1 LONGITUDINAL CHANGES IN THE DIRECT COST OF IBD CARE IN THE BIOLOGIC ERA

While biologics are significantly costlier than other medical options for IBD, their use may lead to a diminution in downstream health care costs by decreasing the need for hospitalization and surgeries for uncontrolled symptoms or complications. Previously published work from Manitoba has shown that the prevalence of anti-TNF use has been increasing over time, but the impact of this increased penetrance of anti-TNF use on downstream costs is not well described across the population of IBD. We sought to assess the direct costs of care among a population of Canadians with IBD between 2004–2016 We used the Manitoba IBD Epidemiology Database, which contains health care utilization data for all Manitobans diagnosed with IBD from 1984–2016, and all prescription medication since 1996, and direct costs associated with health care utilization since 2004. For every year between 2004 and 2016, we summed all costs of health care utilized by persons with IBD, and separated these costs into inpatient, outpatient,and anti-TNF medications, and determined the per capita cost per year. All costs were standardized to 2015 Canadian dollars. Univariate linear regression analysis was used to determine if there are significant changes in the direct costs of care over time. The year by year direct health care expenditure for CD, UC, and IBD are shown in the Figure. Between 2004 and 2016, the mean annual costs of care for persons with IBD increased from $5,648 to $10,232, with an average increase of $447 per year (95%CI: $393-$501) The annual cost for CD increased from $6,549 to $13,373 (annual increase $638, 95%CI $557-$716), whereas the mean cost per year for persons with UC rose from $4,753 to $7,320 (annual increase $276; 95%CI: $222–330) Mean inpatient costs decreased by $104 per year for CD (95%CI: $59-$109), but did not change over time with UC (mean annual change -$11 (95%CI -$57 - +$35). Mean annual per capita outpatient costs (excluding the cost of anti-TNF therapy) has remained stable over the time period, for CD and UC. Discussion: The direct costs of IBD have markedly increased between 2005 and 2015, and the increase can be nearly completely ascribed to the increasing use of anti-TNF medications. Despite the increased penetrance of anti-TNF use into practice, there has been only a relatively small impact on the amount per capita spent on hospitalizations, and only in CD. The failure of anti-TNF medication use to significantly impact the direct costs of care represents a gap between the demonstrated efficacy of these medications and their real-world effectiveness. This suggests that there exist opportunities to further optimize our use of anti-TNF medication in clinical practice CCCJanssen Canada

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