Payer-Addressable Burden of Crohn’s Disease in Members Treated with Biologics in the United States: Actuarial Analysis Findings from RAINBOW

Sabyasachi Ghosh, Ian Smith, James Davidson, Tao Fan, Ninfa Candela, Cynthia Tsang, Troy Koch and Jason Fehr

North American Actuarial Journal, 2023, vol. 27, issue 4, 619-629

Abstract: Payer-addressable burden (PAB) reflects how real-world disease-associated costs impact the per member per month (PMPM) budget of a health plan, and can help to delineate drivers of PMPM costs and inform cost-management strategies for diseases with a high cost burden, such as Crohn’s disease (CD). We aimed to evaluate the U.S. PAB of CD managed with biologics. Weighted mean costs per member with CD in the commercial health plan population between 2017 and 2019 were evaluated from a health plan actuarial perspective. In addition to the overall population of members with CD treated with adalimumab, infliximab, vedolizumab, or ustekinumab, the subpopulations of members who were naive to biologic therapies at treatment initiation and/or treatment-adherent members were also analyzed. Members treated with vedolizumab contributed the lowest PMPM costs. A similar number of members were treated with vedolizumab and ustekinumab, yet PMPM costs associated with ustekinumab were more than double those of vedolizumab. Biologic naivety and treatment adherence drove lower CD-related PMPM costs. The analyses we present here highlight that treatments and patient subgroups with lower PMPM costs are important focus areas for payers in terms of identifying strategies to manage the budget for CD in a U.S. plan population.Video AbstractRead the transcriptWatch the video on Vimeo© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC

Date: 2023
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DOI: 10.1080/10920277.2022.2102041

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