S53 Comparison of Real-World Healthcare Resource Utilization Among Advanced Therapy-Experienced Patients With Ulcerative Colitis Initiated on Ustekinumab or Vedolizumab
Bibliographic record
Abstract
Background: Among patients with ulcerative colitis (UC), prior exposure to biologics or other advanced therapies is associated with reduced response to future therapies, which may lead to higher healthcare resource utilization (HRU). Real-world HRU data among advanced therapy-experienced patients with UC is lacking. This study aimed to compare HRU among patients with UC initiated on ustekinumab, an anti-interleukin 12/23 antibody, or vedolizumab, an anti-integrin biologic. Methods: Adults with UC initiated on ustekinumab or vedolizumab (index date) between 10/21/2019 and 03/02/2022 were selected from the IQVIA PharMetrics® Plus database. Patients were advanced therapy-experienced (i.e., had ≥1 claim for a non-index UC-indicated biologic or advanced therapy agent) in the 12-month baseline period before the index date. Patients with other autoimmune diseases during the baseline period were excluded. Cohorts were balanced on baseline characteristics using inverse probability of treatment weights. HRU outcomes, including all-cause and UC-related number of inpatient (IP) visits and days, emergency department (ED) visits and outpatient (OP) visits, were described during the follow-up period (i.e., index date till earliest of end of data or health plan eligibility) per-100 patients-per-month. Further, all HRU outcomes were compared between the weighted cohorts using weighted Poisson regressions. Results: There were 647 patients in the weighted ustekinumab cohort (mean age: 41.9; 49.1% female) and 1,152 patients in the weighted vedolizumab cohort (mean age: 41.7; 47.0% female). The mean duration of follow-up was 14.9 months for the ustekinumab cohort and 15.7 months for the vedolizumab cohort. During the follow-up period, the ustekinumab cohort had a mean of 1.43 all-cause IP visits and 7.94 all-cause IP days; while the vedolizumab cohort had a mean of 2.06 all-cause IP visits and 15.89 all-cause IP days; the vedolizumab cohort had a 44% higher rate of IP visits (rate ratio [RR]: 1.44; 95% confidence interval [CI]: 1.08-2.07; p-value: 0.012) and double the rate of IP days (RR: 2.00; 95% CI: 1.34-3.28, p-value: < 0.001). Further, the mean number of all-cause ED visits was 5.84 for the ustekinumab cohort and 7.47 in the vedolizumab cohort; the vedolizumab cohort had 28% higher rate ED visits (RR: 1.28; 95% CI: 1.01-1.64, p-value: 0.048). Moreover, the mean number of all-cause OP visits was 185.73 for the ustekinumab cohort and 224.59 for the vedolizumab cohort; the vedolizumab cohort had 21% higher rate of OP visits (RR: 1.21; 95% CI: 1.07-1.35, p-value: 0.004). Similar trends were observed for UC-related HRU across both cohorts. Conclusions: Advanced therapy-experienced patients with UC treated with ustekinumab had significantly lower healthcare resource utilization than patients treated with vedolizumab. These results may help inform healthcare providers in managing patients with prior advanced UC therapies.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
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".