MA2 Comparison of Health Care Costs for Crohn's Disease Patients Who are Adherent Versus Intermittently Adherent with Infliximab Therapy
Bibliographic record
Abstract
Adherence comparisons of biologic agents used to treat Crohn's disease (CD) have typically compared adherent and non-adherent patients. Non-adherence may be due to efficacy, tolerability, lack of follow-up or patient-centered reasons. There is a need for a more in-depth examination of non-adherence. Purpose was to compare healthcare costs of CD patients who were adherent vs. intermittently adherent on infliximab (IFX) therapy. Patients with >1 claims for IFX initiated between 1/1/2006-12/31/2009 who had >2 diagnoses of CD (ICD-9-CM: 555.XX) during the pre-index period were identified from Thomson Reuters Marketscan® Databases. Patients had to be >18 years, continuously enrolled for 12 months before and after IFX initiation, and had no prior use of IFX during 360-days pre-index. Patients with prior biologic therapy or rheumatoid arthritis (ICD-9-CM: 714.XX) were excluded. Adherent group was classified as having a medication possession ratio (MPR) of >80%; intermittently adherent group had an MPR<80% with IFX claims spanning 90% or more of the observation period. Differences between the adherent and intermittently adherent groups were assessed using propensity-weighted general linear models. A total of 599 CD patients were identified (360 adherent; 239 intermittently adherent) with a mean (SD) age of 42.9 (15.5) and 50.9% were female. Propensity-weighted mean total healthcare costs excluding IFX were $13,097 vs. $20,068 (P<0.0001) for the adherent vs. intermittently adherent groups. Mean all-cause component costs were $2,764 vs. $6,665 (P<0.001) for hospitalizations, and $7,074 vs. $10,196 (P<0.0001) for outpatient visits among the adherent vs. intermittently adherent groups, respectively; no significant cost differences were observed in ER visits, other prescription or total costs (component + IFX). Adherence was associated with lower total non-IFX healthcare costs. Comparison of adherent vs. intermittently adherent patients may provide a conservative test of the effect of adherence since patients that were intermittently adherent have some IFX exposure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".