Vedolizumab and infliximab are biologic therapies approved for the treatment of moderate to severe ulcerative colitis (UC) and Crohn's disease (CD) administered by intravenous (IV) infusion. Based on their prescribing information, it is recommended that infliximab be administered over 2 hours compared to 30 minutes for vedolizumab. Infusion administration is reimbursed by health plans on an hourly basis using billing codes for IV infusion or chemotherapy. This study's aim was to assess the number of additional hours billed for infliximab infusions compared to vedolizumab using infusion administration billing codes and to estimate potential productivity loss associated with a second hour of infusion from the perspective of both the patient and employer.Methods:
This study used real world infusion administration billing data from the Symphony Health Integrated Dataverse (“Symphony”) dataset and hourly wage estimates from the United States Bureau of Labor Statistics (BLS) to model productivity loss for an inflammatory bowel disease (IBD) sample. Average June 2016 hourly wage estimates for private industry were obtained from BLS to estimate productivity loss. Results were reported for IBD patients combined, separately by CD and UC diagnosis, and per a hypothetical 1000 patients per year. Productivity loss was defined as time away from work or personal activities and did not include travel time or wait time. Costs were estimated using the human capital method.Results:
The study sample was geographically dispersed, primarily commercial insurance (83.7%), with an average age of 40.4 years, and 52.0% female. The majority of patients were diagnosed with CD (64.8%) and the remainder had UC (35.2%). Of all infliximab patients (n = 10,051) with a first hour infusion administration claim, 96.1% had an additional hour claim, compared to vedolizumab patients (n = 3114) with 2.8% having an additional hour claim. The additional hour administration code use was similar for different sites of care (e.g., home infusion, hospital outpatient, and physician's office). Infliximab patients spent a total of 46,462 extra hours on “second hour” administration time than vedolizumab patients. This resulted in an additional 46,051 hours loss of productivity for infliximab patients compared to vedolizumab patients, translating into $1,179,366 (range $676,029–$1,769,279) in total work productivity loss for infliximab patients over vedolizumab patients per year. For a hypothetical 1000 patients per year, an additional 6767 hours are lost for infliximab, which results in $173,306 (range $99,341–$259,993) in lost productivity compared to vedolizumab. The study findings were similar by diagnosis between CD and UC.Conclusions:
Using real world infusion billing claims data and estimates from BLS, the use of infliximab results in greater productivity loss in terms of time and cost for IBD patients compared to vedolizumab, with similar results for both CD and UC. This study is the first that assessed the economic impact of the recommended 2 hours infliximab and 30 minutes vedolizumab infusion administration times from the perspective of the patient and employer.