ASSESSMENT OF INFLIXIMAB UTILIZATION PATTERNS ACROSS DIFFERENT SITES OF CARE FOR COMMERCIAL HEALTH PLANS

Purpose: Various sites of care (SOC) exist for the administration of infusible therapies, such as infliximab (IFX).  Multiple site characteristics may be important to healthcare decision-makers when evaluating SOC options, including drug utilization patterns.  The purpose of this study was to report IFX vial utilization patterns for in-office infusion settings (IOI), hospital outpatient departments (HOPD), and alternate sites of care (ASOC).  

Method: IFX claims were analyzed between 1/1/2010 and 12/31/2010 from the data of 74 United States commercial insurers representing approximately 192 million covered lives. IFX claims for a mixed population of patients (e.g., with/without biologic experience) were identified by J Code (1745) and ICD-9 codes (720.x, 555.x, 556.x, 714.x, 696.0, 696.1).  The number of IFX vials per infusion (VPI) was derived from Health Care Procedure Code System entries and verified by charges.  Mean VPI was analyzed across the aforementioned sites of care.  Data were further analyzed across different regions of the United States (U.S.).

Result: Of the 420,430 IFX claims, 47% were for rheumatoid arthritis (RA) and 37% were for inflammatory bowel disease (IBD; Crohn’s disease [CD] or ulcerative colitis [UC]).   Seventy-nine percent of the RA and IBD claims were from the IOI setting, with only a minority of infusions being associated with HOPD or ASOC facilities (approximately 18% and 3%, respectively).  The 2010 mean VPI for RA was 4.54, 4.90, and 4.78 in IOI, HOPD, and ASOC settings, respectively.  Similarly, the mean VPI for CD and UC were 5.00, 4.92, 4.95 and 4.70, 4.98, 4.68, respectively, for IOI, HOPD, and ASOC.  IFX utilization was consistent across the different geographic regions of the U.S.

Conclusion: These findings indicate that IFX utilization is similar for RA and IBD and consistent across different sites of care (i.e., IOI, HOPD, and ASOC), with a mean utilization of ≤ 5 vials per infusion.  Therefore, utilization patterns do not appear to be a differentiating factor across the various SOC settings.  Evaluation of other factors such as patient satisfaction, patient adherence, and costs may be useful in further characterizing existing SOC options, thereby supporting SOC decision-making by stakeholders.