AIBD 2010: Do IBD Patients Skip Treatment Due to High Medication Costs?

Although treatment for IBD is expensive, adherence reduces hospitalizations, complications, and other factors that increase the cost of care.

Although the cost inflammatory bowel disease (IBD) medications may be high, the overall cost of treatment appears to be lower if patients remain compliant with their prescribed medications and treatment regimen, as adherence reduces hospitalizations, surgeries, emergency department and outpatient visits, and endoscopy and radiology use, according to research presented at the 2010 Advances in Inflammatory Bowel Diseases, the Crohn's & Colitis Foundation's Clinical & Research Conference, being held December 9-12 in Hollywood, FL.

During a session focusing on treatment adherence and other topics in IBD, Russell Cohen, MD, Associate Professor of Medicine and Co-director of the Inflammatory Bowel Disease Center at the University of Chicago Medical Center, discussed the relationship between medication costs and treatment compliance and patient outcomes.

In one study, completed at the University of Chicago, treatment of patients with IBD with infliximab led to decreased hospitalizations, surgeries, outpatient and inpatient visits, endoscopy, and pathology and radiology costs; reducing the overall costs associated with IBD treatment. In another study completed in the United Kingdom, infliximab decreased surgical operations, examinations under anesthesia, and diagnostic procedures, resulting in an overall cost savings of $216 per patient.

In the ACCENT I study, the investigators showed that more time spent in remission was associated with a three-fold decrease in hospitalizations, and a five-fold decrease in hospitalized days and surgeries. The ACT I and II studies showed similar findings, with the number of hospitalizations and percent of patient hospitalizations decreasing with infliximab use.

In terms of compliance, only 40% of 94 outpatients with ulcerative colitis (UC) were adherent with maintenance 5-ASA in a 2006 study, with UC recurrence correlated with non-adherence. In another study evaluating 64 UC patients, the investigators found that disease activity was also correlated with non-adherence to medication. The main reason IBD patients are not taking their medications appears to be due to forgetfulness, followed by lack of perceived benefit, fear of adverse events, and cost issues.

While cost is an issue cited by some patients, it does not appear to the biggest hindrance to widespread compliance. However, Cohen questioned whether compliance depends mainly on medication costs and concluded that the data in the literature remains mixed. In one study evaluating 4,313 continuously enrolled patients in Maryland CareFirst Blue Cross Blue Shield, investigators found that the annual costs of treatment were lower if patients were persistent with 5-ASA therapy. Other studies have also found that the overall cost of treatment was lower if patients were compliant with their IBD medication.

Cohen concluded that medication costs may be offset by improved outcomes, with compliance and adherence leading to better outcomes and lower overall costs, even if medication costs are higher.