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292

IMPACT OF STEROID DISCONTINUATION ON HEALTH CARE COSTS IN PATIENTS WITH CROHN’S DISEASE

BG Feagan¹, EV Loftus², MA Kamm³, J Chao⁴, P Mulani^4
1London Health Sciences Centre, University of Western Ontario, London, Ontario; ²Mayo Clinic, Rochester, MN, USA; ³St Mark’s Hospital, Harrow, United Kingdom; ⁴Abbott, Abbott Park, IL, USA

AIMS: To determine if discontinuation of steroid use (SU) among patients with Crohn’s disease (CD) lowers health care costs. SU is associated with considerable morbidity and could therefore have an important economic impact in CD. Steroids may also be surrogates for disease severity.
METHODS: Patients with CD-related SU were selected from an Integrated Health Care Information Services managed-care database (1999-2005). To be included in the analysis, pts must have had a CD diagnosis within 30 days and continuous insurance coverage eligibility for 3 months prior to the index date (first date of CD-related SU). Patients with SU 60-90 days after the index date were steroid maintainers (SM); all others were steroid discontinuers (S-). Health care costs (total and CD-related) of S- and SM were evaluated over 6 months and compared descriptively (Un-Adjusted). A regression-adjusted model was used to control for baseline (BL) characteristics (demographics, comorbidities, BL CD-related and non-CD related costs) and compare the same groups. Costs were adjusted for inflation to 2005 US dollars.
RESULTS: Of 9,811 selected CD patients, 5,614 were S- and 4,197 were SM. Mean age was 43.1 years for both groups, with 44.4% (S-) and 46.7% (SM) males. Prior total and CD-related costs were similar between groups. In the follow-up period, both total and CD-related costs were statistically significantly lower for S- when compared with SM (both p<0.0001) (Table). Total and CD-related costs were statistically significantly lower for S- when compared with SM (both p<0.01) using the regression-adjusted model. Significantly lower CD-related costs were observed in the S- group for all health care cost components, including inpatient, outpatient, and prescription drug costs.
Table. Total and CD-Related 6-Month Health Care Costs by Steroid-Use Status                              

Patient Group	Un-Adjusted Costs*	Un-Adjusted Costs*	Regression-Adjusted Costs*	Regression-Adjusted Costs*
	Total	CD-related	Total	CD-related
SM (n=4,197)	10,786	5,270	9,513	5,352
S- (n=5,614)	7,759†	3,275†	8,477‡	3,209‡

 *All costs presented in 2005 US dollars. †p<0.0001 and ‡p<0.01, both vs. SM.
CONCLUSION: Patients with continuous SU incurred substantial total costs in this study. Significantly lower total and CD-related health care costs were associated with steroid discontinuation. Steroid discontinuation may therefore have important cost implications for society and third-party payers. Therapies that allow patients to discontinue steroids may yield cost savings.
Funded by Abbott Laboratories

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