Goals: Surgery accounts for one half, and hospitalizations for one third, of overall costs for patients with Crohn's disease (CD). Infliximab induces remission and heals fistulas in CD but is more costly than traditional therapies. Its impact upon resource use in CD is unknown.
Study: The medical records were reviewed for all CD patients managed at our institution for at least 1 full year both before and after initial infliximab infusion. The incidences of hospitalizations, hospitalized days, surgeries, endoscopies, radiologic examinations, outpatient and emergency room (ER) visits were studied (weighted according to time period).
Results: There were 79 patients (59% female, mean age 38.6 years). A decrease was seen in the annual incidence of all surgeries (38%, p < 0.01), gastrointestinal (GI) surgeries (18%, p < 0.05), endoscopies (43%, p < 0.01), ER visits (66%, p < 0.05), all outpatient visits (16%, p < 0.05), outpatient GI visits (20%, p < 0.01), all radiologic examinations (12%, p < 0.01), and non-plain films (13%, p < 0.01). Fistula patients (n = 37) had decreases in hospitalizations (59%, p < 0.05); GI surgeries (59%, p < 0.01); all surgeries (66%, p < 0.01); all, GI, and surgical outpatient visits (27%, 26%, and 70%, respectively, p < 0.05 for all); ER visits (64%, p < 0.05); all radiologic examinations (40%, p < 0.05); and non-plain films (61%, p < 0.05). Patients with luminal disease(n = 42) had decreases in endoscopies (52%, p < 0.05), and ER visits (69%, p < 0.05). Patients of both genders and all ages experienced decreases in resource use.
Conclusion: Patients with CD decreased their use of some services, with a decreased number of hospitalizations and a decrease in the use of surgical services seen primarily in the patients infused for fistulas. This decrease in use of healthcare resources raises the potential of overall cost savings in CD patients receiving this drug.