Background Treatments for Crohn’s disease (CD) or ulcerative colitis (UC) include anti-TNFs and novel therapies, but optimal real-world treatment sequencing has not been well-studied. This study compared healthcare resource use (HRU) and costs associated with switching from initial anti-TNF therapy to either vedolizumab (VDZ) or another anti-TNF. Methods CD or UC patients who switched from 1st-line anti-TNF to adalimumab (ADA), infliximab (IFX), other (OT) anti-TNF (certolizumab pegol for CD, golimumab for UC), or VDZ were included from a large claims database (1/2000-9/2015). Patients had ≥6 months insurance coverage pre-(baseline) and post-(follow-up) the switch date to anti-TNF or VDZ (index date). Patient characteristics, HRU, and costs were assessed at baseline. HRU and costs were compared between VDZ vs. ADA, IFX, or OT switchers in follow-up with multivariate analyses, adjusted for age, sex, comorbidities, and disease severity proxies (HRU, costs, immunomodulator, steroid, and narcotic use at baseline). Results In CD, 116, 1,365, 518 and 536, and in UC, 89, 310, 152 and 99, VDZ, ADA, IFX and OT switchers were identified. Demographics were similar across cohorts. IFX and VDZ patients had similar disease severity, estimated by proxies ; ADA and OT patients had less severe disease. All-cause adjusted costs were significantly higher for VDZ compared to ADA switchers for CD and UC patients, and compared to IFX or OT switchers for CD patients (Table 1). Adjusted HRU was similar between cohorts (Table 2), but VDZ switchers with CD had a significant increase in emergency room visits vs. ADA, IFX, and OT switchers (incidence rate ratios=1.8, 1.6, 1.8, respectively, p<.05). Conclusion CD and UC patients who switched to VDZ from 1st-line anti-TNF had higher total costs and no incremental benefits in HRU compared to those who switched to another anti-TNF. Prospective studies are needed to assess the cost-effectiveness of switching biologic classes in UC and CD patients.
