P-092 Economic Impact of Infusion Administration Time Billing for Vedolizumab and Infliximab for Ulcerative Colitis and Crohn's Disease: Health Plan Perspective

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Vedolizumab and infliximab are biologic treatments for moderate to severe Crohn's disease (CD) and ulcerative colitis (UC) administered by intravenous (IV) infusion. Based on the package insert, infliximab is typically administered over a period of 2 hours, and vedolizumab is administered over approximately 30 minutes. IV-infused treatments are reimbursed by health plans on an hourly basis using Current Procedural Terminology (CPT) codes for IV infusion or chemotherapy. As such, the shorter infusion time for vedolizumab is expected to result in less second hour billing than infliximab in real-world claims data. The study aim was to evaluate the economic impact of infusion time for vedolizumab and infliximab to a hypothetical health plan in the United States.


The Symphony Health Integrated Dataverse “Symphony,” a comprehensive dataset containing longitudinal pharmacy and medical claims from multiple health plans, hospital systems, and pharmacy networks, was used to assess the use of second hour billing and its associated costs from May 20, 2014 to February 29, 2016. An economic model was developed for a hypothetical health plan population of 10 million members to assess the budget impact of vedolizumab and infliximab infusion costs. Model inputs were derived from the Symphony dataset and from published epidemiology, treatment, and cost data. Infusion administration costs were estimated by multiplying the infusion billing code by the unit cost per additional hour of infusion for chemotherapy (CPT 96415: $28.64) and IV infusion (CPT 96366: $18.98). Sensitivity analysis was conducted by varying model inputs including the infusion administration fee schedule and market share.


Using claims information from the Symphony dataset, 13,165 inflammatory bowel (IBD) patients with at least one infusion administration claim (infliximab n = 10,051; vedolizumab n = 3114) were identified. Of all infusion administration claims identified for infliximab (n = 48,377), 46,462 (96.1%) were for second hour billing claims compared to 14,714 vedolizumab claims, of which 411 (2.7%) were for second hour billing claims. When the unit cost of each second hour billing CPT code was applied to the utilization estimates, it resulted in cost-savings of $1,268,070 for second hour billing in vedolizumab compared to infliximab. Simulating a 10 million member health plan and using prevalence estimates from the literature, approximately 6689 IBD patients would be treated with a biologic in a given year, resulting in an estimated 48,495 infusion claims. Assuming all patients were treated with infliximab or vedolizumab, the model projected 45,265 extra second hour billing for infliximab over vedolizumab, and estimated $1,248,410 in administration billing savings with vedolizumab for the health plan. The model results were not impacted by sensitivity analyses varying the infusion administration fee schedule and the treatment market share.


Using a claims database, this study showed significantly less second hour infusions associated with vedolizumab compared to infliximab. Using economic modeling, this study further estimated potential cost savings up to $1,248,410 for vedolizumab second hour administration billing compared to infliximab for a hypothetical health plan. As such, infusion time and administration billing could have significant economic impact when managing IBD patients.

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