Healthcare Resource Utilization and Costs in Crohn's Disease and Ulcerative Colitis Patients Initiating Ustekinumab

OBJECTIVES: Research on Healthcare resource utilization (HCRU) and costs among IBD patients using ustekinumab is limited. This study aimed to evaluate HCRU and related costs in patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) who received ustekinumab through Janssen’s patient support program (PSP) in Ontario, Canada.

METHODS: This retrospective observational study examined data from Ontario patients with CD and UC who started ustekinumab treatment through PSP (January 2017-July 2021 for CD and February 2020-July 2021 for UC). Using quasi-identifiers (date of birth, sex, postal code, indication), patients in PSP were linked to data from the Institute for Clinical Evaluative Sciences (ICES).Annual IBD-specific HCRU and costs were reported for one year pre-UST initiation and up to four years post-UST initiation. Mixed gamma regression and negative binomial models were used to compare costs and HCRU before and after.

RESULTS: Successful probabilistic linkage was achieved for 88.1% of patients, which represents 2,279 CD cases and 626 UC cases. Ustekinumab was the initial biologic therapy for 35.7% of CD patients and 22.6% of UC patients. The mean age was 45.6 for UC and 45.7 years for CD patients.

IBD-specific HCRU and non-medication costs significantly decreased post-ustekinumab initiation in years 1, 2, and 3 for both CD and UC patients, compared to baseline. In year 2 specifically, inpatient hospitalization costs dropped by 43.7% for CD (baseline $1,642 vs. follow-up $925, p=0.0001) and 67.3% for UC (baseline $2,315 vs. follow-up $756, p=0.0011). Total physician visit costs fell by 33.6% for CD (baseline $728 vs. follow-up $483, p<0.0001) and 45.8% for UC (baseline $858 vs. follow-up $465, p<0.0001).

CONCLUSIONS: There was a substantial reduction in IBD-specific HCRU and non-medication costs among patients with CD and UC who initiated ustekinumab through Janssen’s PSP in Ontario, Canada. Future inclusion of patient-reported outcomes alongside economic data is recommended.