# Healthcare resource utilization and production loss in vedolizumab-treated inflammatory bowel disease patients: results from the Swedish prospective multicentre SVEAH study

## TL;DR

This study analyzed the healthcare costs and productivity losses of IBD patients in Sweden treated with vedolizumab, finding high direct costs but lower indirect costs for those who continued treatment.

## Contribution

The study provides new empirical data on the economic burden of vedolizumab-treated IBD patients in a real-world clinical setting.

## Key findings

- The mean annual direct cost for IBD patients was €24,305, with medication being the largest cost driver (64%).
- Patients who continued vedolizumab had significantly lower indirect costs (€3,044) compared to those who discontinued (€8,927).
- Perianal disease and high baseline disease activity in Crohn’s disease were associated with increased direct costs.

## Abstract

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

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

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.

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).

The mean annual direct follow-up cost was €24,305 for all IBD patients, €24,873 for CD patients and €23,484 for UC patients (p = 0.24). No difference was observed between men and women (€24,506 vs €24,080; p = 0.87). Direct costs were similar in patients who continued vedolizumab for the entire study period (€24,401) and those who discontinued treatment (€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 (€3044) than among those who stopped the treatment (€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.

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.

Healthcare use and productivity loss in inflammatory bowel disease patients treated with vedolizumab: results from the Swedish SVEAH study

Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory disorder of the gastrointestinal tract. The two main types of IBD are Crohn’s disease and ulcerative colitis. IBD causes significant illness and can lead to complications like bowel blockages, fistulas, infections, and cancer, which create a heavy economic burden on society and healthcare. Vedolizumab is a biological treatment that was approved for treating IBD in 2014. A previous Swedish study, called the SVEAH study, showed that vedolizumab is effective in routine care. However, the cost of vedolizumab is higher than that of conventional therapies, costing over €10,000 per treatment year, depending on the country, healthcare system, and dosage.

The purpose of this study was to examine healthcare costs and productivity losses, such as sick leave, in patients treated with vedolizumab. To do this, we used the Swedish personal identification number to collect data from Swedish health registers for the participants in the SVEAH study.

We found that the average healthcare cost per patient was €24,305. Medication was the largest contributor to direct costs (64%), followed by hospital admissions (19%) and outpatient care (17%). Direct healthcare costs were similar for patients who continued vedolizumab throughout the study (€24,401) and those who stopped treatment (€24,192). However, productivity losses were lower for patients who continued vedolizumab (€3,044) than for those who stopped treatment (€8,927). High disease activity and the presence of perianal disease, such as abscesses or fistulas, were linked to higher costs in Crohn’s disease. Patients with ulcerative colitis who used immunomodulators alongside vedolizumab also had higher costs.