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DIRECT COSTS


can achieve remission using drugs instead of surgery, for both CD and UC.60,61,62,63


This has


changed the type of costs that are incurred for CD and UC over previous years. This creates a problem when measuring medical costs.


To get a current estimate of prescription drug use, a national drug claims database was used to identify prescriptions for the typical drugs used to treat IBD.64


Many of these drugs can


be used for non-IBD diseases, so total cost was factored by the percentage of use that was specific to IBD indications. Drug claims data across public and private payers showed that costs for the most recent year (2011) totaled $460 million. About 84% of these costs were for the biological drugs infliximab and adalimumab. There has been steady and significant growth in drug costs over the past several years, as biologicals have become the standard of care for people with more severe disease. For example, an analysis of IBD drug claims in Manitoba for 2005/6 showed that biologicals comprised about half of the total cost of prescription drugs at that time.65


Using conservative growth estimates, prescription drug claims could cost at least


$521 million in 2012. This figure excludes costs for patients who pay out of pocket for drugs – those who have neither a public nor a private drug plan to pay for their drugs. However, at least for the biologicals, most people cannot afford to pay out of pocket, so these products are almost all paid within drug plans. It was conservative to exclude drug costs that are borne by the individual, although they may be significant and a burden to the person and family.


The biological drugs are quite expensive, for example, infliximab, a prescription intravenous (IV) infusion medication used to treat patients with Crohn’s disease and ulcerative colitis are given based on an individual’s weight. An average-sized adult can expect to be billed approximately $4,333 for each infusion66


, and infusions are given every 6 to 8 weeks which


can lead to individual patient costs approximately $20,000 to $50,000 per year depending upon the dose and frequency of treatment. Many health insurance policies have out-of-pocket maximums that limit a patient’s expenses. But those maximums vary greatly, leaving many insured individuals to face thousands of dollars in annual expenses. In Canada, ten provincial and two territorial drug plans pay 46% of that total, private insurance and workplace health plans 36%, and uninsured patients 18%, according to the Canadian Institute for Health Information67


Canadian research shows that biological-users required substantial health care resources before they receive biologicals.65,68


people who receive them incur high levels of health care costs. However, In other words, people who were prescribed biologicals


were those who required frequent physician visits and/or expensive hospitalizations and surgeries due to difficulties with their IBD in the year before being prescribed a biological. After about two years, rates of hospitalization and physician visits fell back to the levels that were seen in other people with IBD. This suggests that biological drugs can improve IBD-related health outcomes.


There were important differences in costs across the country, with per-capita drug costs twice as large in some provinces as in others. This could reflect differences in treatment practices or differences in access (funding) available for the biological drugs. There was also a three- fold difference in the percentage of drug costs that was paid for by public plans versus private plans. This is due to the differences between the provincially-administered public drug plans, in both the type of drug that is funded and the extent of the population that is covered.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 48


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