International Journal of Clinical Pharmacy

, Volume 38, Issue 4, pp 880–887 | Cite as

Resource use and cost of care with biologicals in Crohn’s disease in South Africa: a retrospective analysis from a payer perspective

  • Jacqui MiotEmail author
  • Susan Smith
  • Niri Bhimsan
Research Article


Background Crohn’s disease is a relapsing remitting inflammatory disease of the gastrointestinal tract. Treatment may require expensive biological therapy in severe patients. Affordability of the high cost anti-TNF-α agents has raised concern although evidence suggests cost-offsets can be achieved. There is little information on the resource utilisation of Crohn’s patients in low and middle income countries. Objective The objective of this study is to investigate the resource utilisation and costs associated with biologicals treatment of Crohn’s disease. Setting The setting for this study is in private healthcare in South Africa from a payer perspective. Method A retrospective longitudinal analysis of an administrative claims database from a large private healthcare insurer of patients who had at least 1 year claims exposure prior to starting biologicals and 2 years follow-up thereafter. Resource utilisation and costs including total Crohn’s costs, hospital admissions and surgery, out of hospital costs, biologicals and chronic medicines were analysed. Main outcome measure The primary objective was to compare the change in resource utilisation and costs for Crohn’s related conditions before and after starting biological treatment. Results A cohort of 72 patients was identified with a 35% (p = 0.005) reduction in Crohn’s related costs (excluding the cost of biologicals) from ZAR 55,925 (U$5369) 1 year before compared to ZAR 36,293 (U$3484) 2 years after starting biological medicines. However, inclusion of the cost of biologicals more than doubled the total costs to ZAR 150,915 (±91,642) U$14,488 (±8798) in Year 2. Significant reductions in out-of hospital Crohn’s related spend was also observed. Conclusions A reduction in healthcare costs is seen following starting biologicals in patients with moderate to severe Crohn’s disease. However, the high cost of biological therapy outweighs any possible savings achieved in other areas of healthcare utilisation.


Biologicals Clinical pharmacology Cost Crohn’s disease Pharmacoeconomics South Africa 



Acknowledgments go to Rose Moore who assisted with the data analysis and Noluthando Nematswerani who reviewed the final article.


No external funding was provided for this study.

Conflict of interest

J.M. has carried out educational training for Novartis and serves as a consultant for Discovery Health. N.B. and S.S. declare no conflict of interest.


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Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  1. 1.Department of Pharmacy and Pharmacology, Faculty of Health Sciences, School of Therapeutic SciencesUniversity of WitwatersrandJohannesburgSouth Africa
  2. 2.Clinical Policy UnitDiscovery HealthSandtonSouth Africa

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