Background: The anti-TNFα agent Infliximab (IFX) is used for
the treatment of moderate to severe inflammatory bowel
disease (IBD) with insufficient response to conventional
immunomodulator therapy. IFX maintenance therapy is
expensive and it is unknown if indirect costs (eg. by loss of work
productivity) can be reduced by this therapy. Goal: to evaluate
the direct and indirect costs of an IBD patient cohort under
maintenance IFX compared to a cohort under "conventional"
immunomodulator therapy. Methods: Direct and indirect costs
of an IBD cohort under IFX and a reference cohort (similar
disease activity and location) under conventional
immunomodulator therapy (Azathioprine, or 6-MP, or MTX)
were retrospectively evaluated over 12 months (January to
December 2008). Results: 54 IFX-patients (24f/30m, 37 CD, 10
UC, 7 IC) and 71 non-IFX-patients (38f/33m, 56 CD, 12 UC, 3
IC) were included. IFX patients were younger than non-IFX
patients (36 vs. 47 years, P = 0.0003). The mean duration of
inpatient stay in hospital (23 in IFX vs. 21 days for non-IFX, P =
0.909) and the hospitalization costs (7,692 in IFX vs. 4,179 SFr
for non-IFX, P = 0.4540) did not differ. IFX-patients had
significantly more frequently specialist outpatient consultations
(8 vs. 4, P < 0.001) and outpatient-related costs (3,633 vs.
2,186 SFr, P <0.001). Total costs for all diagnostic procedures
(blood work, endoscopies, radiology) were higher in the IFXcohort
(2,265 vs. 1,164 SFr, P < 0.001). Sixty-five percent of
IFX-patients had a 100% job employment compared to 80% in
the non-IFX cohort (P = 0.001). Conclusions: The direct and
indirect costs of maintenance IFX-treated IBD patients are
higher compared to IBD patients under conventional
immunomodulators. Care should be taken not only to judge the
costs as the IFX treated population may represent a cohort with
more aggressive disease phenotype, furthermore, quality of life
aspects were not assessed.