Drug utilization and cost associated with inflammatory bowel disease management in Saudi Arabia

Yazed AlRuthia; Othman Alharbi; Abdulrahman M Aljebreen; Nahla A Azzam; Majid A Almadi; Ohud H Bahari; Khalid A Almalki; Abdulaziz T Atham; Ahmed S Alanazi; Maria Saeed; Baraa HajkhderMullaissa; Mohammad Alsenaidy; Bander Balkhi

doi:10.1186/s12962-019-0194-3

Drug utilization and cost associated with inflammatory bowel disease management in Saudi Arabia

Cost Eff Resour Alloc. 2019 Dec 4:17:25. doi: 10.1186/s12962-019-0194-3. eCollection 2019.

Authors

Affiliations

¹ 1Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451 Saudi Arabia.
² 2Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
³ 3Gastroenterology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
⁴ 4Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada.
⁵ 5Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.

Abstract

Background: There has been an increase in incidence and prevalence of inflammatory bowel disease (IBD) outside the western countries. Treatment costs are an essential component for healthcare planning and priority setting. The utilization patterns and annual administration and cost of IBD medications are largely unknown in countries with an increasing incidence of disease, Saudi Arabia being an example.

Aim: To evaluate the use of non-biologic and biologic agents and their associated annual administration costs in a sample of patients with Crohn's disease (CD) and ulcerative colitis (UC) in Saudi Arabia.

Methods: Single-center retrospective chart review was performed to determine the use of biologic and non-biologic medications among IBD patients in a tertiary care hospital in Riyadh, Saudi Arabia. Daily and the annual acquisition cost of different IBD therapeutic agents was calculated. The utilization rates and cost of each type of medication by CD and UC patients were compared.

Results: Data of 258 CD patients and 249 UC patients were analyzed. Infliximab and adalimumab were the most commonly prescribed biologics among the study sample, however, their utilization rates were significantly higher among CD than UC patients (36.82% vs. 11.24%, and 20.54% vs. 9.64%, respectively, P < 0. 01). Azathioprine utilization rate was also higher among CD patients compared to their UC counterparts (71.71% vs. 40.16%, respectively, P < 0.01). However, the utilization rate of mesalazine in the UC patients was significantly higher than their CD counterparts (85.53% vs. 14.34% for CD, P < 0.01). The annual cost of biologics (including administration and lab test cost) ranged from 5572 USD for ustekinumab to 18,424 USD for vedolizumab. On the other hand, the annual cost of non-biologics ranged from 16 USD for prednisone to 527 USD for methotrexate.

Conclusion: Biologics are extensively used in the management of IBD, particularly CD, and their utilization costs are significantly higher than non-biologics. Future studies should examine the cost effectiveness of IBD medications especially in countries with increasing incidence such as Saudi Arabia.

Keywords: Colitis, ulcerative; Crohn disease; Drug utilization; Inflammatory bowel diseases.