Economic evaluation of biological therapy use among patients with Crohn's disease

Crohn's disease (CD) is a chronic inflammatory disorder that substantially impairs quality of life for patients and entails enormous economic burden to the US society. Biological therapies can effectively treat Crohn's disease. The treatment strategy of using biological therapy for CD is currently shifting from the conventional 'bottom-up' approach that reserves biological therapy as the last medical resort to a more aggressive 'top-down' approach that endorses early use of biological therapy. This dissertation sought to evaluate the impact of this shift in treatment on healthcare utilization by CD patients and healthcare costs to payers.;First, we examined healthcare utilization and costs for CD patients in a large claims database dating from 2005 to 2009. We found that early biological users had lower utilization of inpatient services and higher prescription drug costs than late biological users. Annual medical costs for both biological user groups were comparable. We constructed a decision tree model and conducted budget impact analysis to predict the financial ramifications for third party payers of the change in prescription drug costs resulting from top-down treatment approach. Our results showed that the top-down approach of biological therapy was associated with increased prescription drug costs in the first year of disease. Incremental drug costs from top-down approach were significantly reduced in the second and third years following CD diagnosis. Last, we conducted a cost analysis to compare total healthcare costs for patients who adopted biological therapy following top-down or bottom-up approach. We found that patients following the top-down strategy incurred higher healthcare costs in the first year of disease. In the second and third years, the top-down strategy appeared to be cost neutral, which was mainly attributed to a cost reduction in non-drug services.;In conclusion, novel biological therapies have been increasingly used among CD patients, and the new top-down treatment strategy can affect allocation of healthcare costs. Top-down treatment approach resulted in higher prescription drug costs for patients, especially in the first year of disease, when compared to patients following the conventional bottom-up approach. The top-down strategy for CD is projected to be cost neutral in the long term.