Early Use of Biologics Reduces Healthcare Costs in Crohn’s Disease: Results from a United States Population-Based Cohort

Ryan C. Ungaro, April N. Naegeli, Casey Kar Chan Choong, Mingyang Shan, Xianming Steve Zheng, Theresa Hunter Gibble, Kathy Oneacre, Jean Frederic Colombel

Research output: Contribution to journalArticlepeer-review


Background: Early initiation of biologics in moderate-to-severe Crohn’s disease (CD) may significantly alter disease progression, resulting in better patient outcomes. Limited real-world data exist on the impact of early biologic use in patients with CD in the United States. Aims: We aimed to characterize biologic initiation and subsequent healthcare resource utilization (HCRU) in adults with recently diagnosed CD. Methods: Patients with CD who initiated biologic treatment within 2 years of diagnosis (index date) were identified from medical and pharmacy claims (Merative L.P. MarketScan Database from 2010 to 2016) and classified as early (≤ 12 months post-index) or late (> 12–24 months post-index) biologic initiators. Propensity score matching balanced patient characteristics up to 1 year post-index. Differences in HCRU frequency and costs 1–2 years post-index were compared between the matched groups. Results: After propensity score matching, 672 pairs of early and late biologic initiators were identified. Patients who initiated biologics early had fewer outpatient visits (15.5 vs 19.8, 95% confidence interval [CI] for difference: 2.7, 6.1) and lower total medical costs ($13,646.20 vs $22,180.70, 95% CI for difference: 4748.9, 12,320.1) 1–2 years post-index than late biologic initiators. Early biologic initiators had higher medication costs 1–2 years post-index ($33,766.30 vs $30,580.70, 95% CI: 546.1, 5825.1) but lower combined medical and medication costs ($47,412.50 vs $52,761.50, 95% CI: 801.5, 9896.40). Conclusions: While biologic treatments are costly, patients initiating biologics sooner after diagnosis appear to have better HCRU outcomes and require fewer healthcare resources at 1–2 years post-index, potentially leading to overall cost savings.

Original languageEnglish
JournalDigestive Diseases and Sciences
StateAccepted/In press - 2023


  • Crohn disease
  • Early intervention
  • Propensity score
  • Top-down treatment
  • Treatment outcomes


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