P805 Patients with Crohn’s disease treated with ustekinumab vs. vedolizumab in real-world settings
Bibliographic record
Abstract
Abstract Background Ustekinumab (UST) and vedolizumab (VDZ) are approved biologic therapies for moderate to severe Crohn’s disease (CD). Comparative data on real-world patient characteristics and healthcare costs for these drugs are scarce. Methods We examined healthcare costs associated with UST (healthcare common procedure coding system [HCPCS]: J3357, J3358, C9261, C9487, Q9989) and VDZ (HCPCS: C9026, J3380) in a retrospective cohort study of Truven commercial claims data (2009–2018) for adults with CD (international classification of diseases-9/10 codes: 555/K50). Eligible patients (18–89 years old) initiated UST or VDZ (index drug) on/after Sept 26, 2016, had CD as the latest relevant autoimmune disease on or before index drug initiation (index) date, ≥6 months of data available both before and after the index date, completed induction, and initiated maintenance therapy. Entropy balancing was used to address confounding factors (baseline characteristics). Primary outcome was healthcare costs assessed from a US payer perspective from index date to treatment discontinuation or end of follow-up (time on treatment). Cost were reported in 2018 US$ per patient per month and compared between treatment groups overall, and for biologic-naïve and -experienced (≥1 pre-index biologic therapy for CD) subgroups, using mean cost differences (MCD) obtained from weighted two-part models. Results The 599 (117 biologic-naive) UST- and 589 (172 biologic-naive) VDZ-treated patients who met eligibility criteria were similar in sex (54% and 57% female), mean age (41 ± 14 and 44 ± 14 years), time since diagnosis (42 ± 33 and 46 ± 35 months) and Charlson comorbidity index (0.4 ± 1.0 and 0.6 ± 1.1). Disease location, follow-up duration, and prior therapies and surgeries were also comparable. Characteristics were similar in biologic-naïve and -experienced patients. Mean weighted time on treatment was 11.4 and 12.1 months in UST- and VDZ-treated patients. Mean weighted total healthcare costs per patient per month was higher with UST vs. VDZ (MCD=$5051) driven by total index drug costs (MCD=$4946; Table). Cost differences were consistent in biologic-naïve and -experienced patients (total cost MCD=$4466 and $4836, both p < 0.01). Conclusion Characteristics of UST- and VDZ-treated patients in real-world settings were comparable. In this population of patients receiving maintenance treatment for CD, index drug costs make UST treatment substantially more costly than VDZ. Further comparison of healthcare outcomes in patients treated with UST vs. VDZ is warranted.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".