The use of biological agents to manage inflammatory bowel disease (IBD; i.e., Crohn's disease [CD] and ulcerative colitis [UC]) has grown markedly in recent years. As the concept of patient-centered medical and home-care services has expanded, patients are no longer receiving these infusions just at conventional infusion centers; they are also receiving these agents at home. However, there is a knowledge gap regarding the safety of home administration of these medications. There is also little information regarding patients' experiences with home-based infusions and the costs that patients incur for these treatments.

A mixed-methods study was performed using retrospective data from an administrative-claims database. A cross-sectional study was also conducted of a large, longitudinal, Internet-based cohort of IBD patients (IBD Partners) to determine the reason why participants received home infusions (HIs), if they preferred HIs to conventional infusions, and if they had encountered any problems receiving the HIs.

Data from the Quintiles IMS Legacy PharMetrics Adjudicated Claims Database from January 2010 to June 2016 were analyzed. Study participants were aged 18 years or older and had a diagnosis of either CD or UC based on at least two healthcare contacts on different days with an associated ICD-9 or ICD-10 code for CD or UC. Patients had to be enrolled in their plan for at least 6 continuous months in order to assess charges and treatment outcomes.

The primary outcome of the retrospective cohort study was emergency-department (ED) or urgent-care visits in the 2 days following either infliximab or vedolizumab HIs. The focus of the cross-sectional survey was to describe the HI population and to report on the charges that they incurred.

In total, 11,892 patients received infliximab in a conventional setting and 1573 received it as an HI. The majority of patients (68% and 70% in the conventional vs. home-care setting, respectively) had CD. The median age of infliximab patients was mid-40s, and more than half were female. Charges were similar for conventional versus HIs of infliximab; most patients had commercial insurance. Among patients who had received infliximab at a conventional infusion center, 3.1% had an urgent-care or ED visit in the 2 days following administration, compared with 2.9% in the HI arm.

For vedolizumab, there were 439 conventional-center users and 138 HI patients, with CD being the predominant form of IBD in both groups (59% and 67% for conventional vs. HI, respectively). Age and gender were similar to those for the infliximab group. In the conventional arm, almost two-thirds of patients used a commercial insurer, while 18% used Medicaid as their primary payer. For those in home care, 82% had conventional insurance and Medicaid was the primary payer for 14%. The charges were a median of $3,200 higher for HI recipients. Among patients who received vedolizumab at a conventional infusion center, 2.5% had an urgent-care or ED visit in the 2 days following administration, compared with 1.4% in the HI arm.

Infliximab was associated with statistically significantly more ED or urgent-care visits. Having a Charlson Comorbidity Index score of >0 was associated with a nearly twofold increase, and using Medicaid as the primary source of insurance was correlated with over a threefold rise in an urgent-care or ED visit.

Of the 644 respondents, 137 received their infusion at a clinic, 440 received infusion at an infusion center, and 56 received HIs. Over one-half (54%) of the patients who were not currently getting HIs indicated that they would be interested in HIs. Only 28% who were not receiving HIs were interested in this option. About one-quarter (27%) of patients who received HIs reported a problem with the HI. However, only two of these patients had had an urgent-care or ED visit.

This article helps identify IBD patients who would be candidates for HI therapy. It provides reassurance for both home-care and specialty pharmacists that the administration of these potent immunologic agents can be safely performed in the comfort and convenience of a patient's home.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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