Non-Drug Costs Associated with Outpatient Infliximab Administration in Pediatric Inflammatory Bowel Disease

Background:Infliximab is the most widely used biological agent for Crohn's disease (CD) and ulcerative colitis (UC) but requires outpatient infusion units because of its intravenous administration requirement. The aim of this study was (1) to determine the average non-drug costs associated with each outpatient use of infliximab for pediatric inflammatory bowel disease and (2) to determine the proportion of non-drug costs associated with each outpatient infliximab use relative to the total cost of each encounter.Methods:Hospital administrative and pharmacy databases were queried for all short stay unit encounters at Lucile Packard Children's Hospital at Stanford University linked to infliximab infusions for inflammatory bowel disease between January 1, 2006, and December 31, 2011. Infliximab drug and non-drug costs associated with CD and UC were compared.Results:A total of 771 unique encounters were generated for 76 pediatric patients (53 CD, 23 UC). For direct costs related to infliximab infusions for either CD or UC patients, more than 77% of the total health care costs per encounter were related to personnel (e.g., nursing), facility operations, and laboratory costs. Only 23% of the total costs were related to the actual infliximab drug costs. Based on an 80/20 payor mix of managed care versus government-subsidized insurance payers, 24.5% of the total reimbursements were applied to non-drug costs in CD and 20.9% in UC.Conclusions:Non-drug costs represent a substantial proportion of the total cost of outpatient infliximab-related actual costs in inflammatory bowel disease. Personnel costs represent the largest segment of the non-drug costs. The actual drug costs of infliximab represent a small proportion of the total costs.