Till Örebro universitet

Background: Data on direct and indirect annual costs for inflammatory bowel disease (IBD) patients treated with vedolizumab are limited.

Objectives: To evaluate the total annual direct healthcare costs and indirect costs among IBD patients treated with vedolizumab.

Design: A prospective observational multicentre study involving 286 patients with Crohn's disease (CD; n = 169) or ulcerative colitis (UC; n = 117) who started vedolizumab therapy during 2015-2017 at 21 hospitals across Sweden.

Methods: Data on direct and indirect costs were collected during a 3-year follow-up period. Direct costs were measured as healthcare resource utilization including medication, hospital admissions and hospital-based outpatient visits. Indirect societal costs were measured as production losses from sick leave and disability pension. Data were obtained from the Swedish Quality Register for IBD and through linkage with national registers. Data are presented both for patients who continued treatment throughout the follow-up period and for patients who discontinued treatment (CD: n = 83; UC: n = 48).

Results: The mean annual direct follow-up cost was <euro>24,305 for all IBD patients, <euro>24,873 for CD patients and <euro>23,484 for UC patients (p = 0.24). No difference was observed between men and women (<euro>24,506 vs <euro>24,080; p = 0.87). Direct costs were similar in patients who continued vedolizumab for the entire study period (<euro>24,401) and those who discontinued treatment (<euro>24,192; p = 0.12). Medication was the primary driver of direct costs (64%), followed by hospital admissions (19%) and outpatient care (17%). Mean indirect costs were lower among patients who continued vedolizumab (<euro>3044) than among those who stopped the treatment (<euro>8927; p < 0.01). Increased direct costs were associated with perianal disease and high baseline disease activity in CD, and concurrent use of immunomodulators in UC.

Conclusion: Patients treated with vedolizumab in Swedish clinical practice represent a group with high direct costs, primarily due to medication expenses. However, indirect costs were significantly lower than in previous reports.