Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 60–67 | Cite as

Reduced Imaging Radiation Exposure and Costs Associated with Anti-Tumor Necrosis Factor Therapy in Crohn’s Disease

  • Seema A. Patil
  • Mark H. Flasar
  • Jay Lin
  • Melissa Lingohr-Smith
  • Martha Skup
  • Song Wang
  • Jingdong Chao
  • Raymond K. CrossEmail author
Original Article



Radiation exposure from diagnostic imaging may increase cancer risk of Crohn’s disease (CD) patients, who are already at increased risk of certain cancers.


To compare imaging radiation exposure and associated costs in CD patients during the year pre- and post-initiation of anti-tumor necrosis factor (anti-TNF) agents or corticosteroids.


Adults were identified from a large US claims database between 1/1/2005 and 12/31/2009 with ≥ 1 abdominal imaging scan and 12 months of enrollment before and after initiating therapy with anti-TNF or corticosteroids. Imaging utilization, radiation exposure, and healthcare costs pre- and post-initiation were examined.


Anti-TNF-treated patients had significantly fewer imaging examinations the year prior to initiation than corticosteroid-treated patients. Cumulative radiation doses before initiation were significantly higher for corticosteroid patients compared to anti-TNF patients (22.3 vs. 17.7 millisieverts, P = 0.0083). After therapy initiation, anti-TNF-treated patients had significantly fewer imaging examinations (2.9 vs. 5.2, P < 0.0001) and less radiation exposure (7.4 vs. 15.4 millisieverts, P <0.0001) than corticosteroid-treated patients in the follow-up period. Reductions in imaging costs adjusted for 1000 patient-years after initiation of therapy were − $275,090 and − $121,960 (P = 0.0359) for anti-TNF versus corticosteroid patients, respectively.


This analysis demonstrated that patients treated with anti-TNF agents have fewer imaging examinations, less radiation exposure, and lower healthcare costs associated with imaging than patients treated with corticosteroids. These benefits do not account for additional long-term benefits that may be gained from reduced radiation exposure.


Crohn’s disease Tumor necrosis factor-alpha Glucocorticoids Diagnostic imaging Cost 



Design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the manuscript. All authors, S. Patil, M. Flasar, J. Lin, M. Lingohr-Smith, M. Skup, S. Wang, J. Chao, R. Cross, contributed to the study design, development of the publication and maintained control over the final content. Carrie Bray of Fishawack Facilitate Ltd. provided editing services in the development of this publication. AbbVie provided funding for this work.

Compliance with ethical standards

Conflict of interest

Seema Patil has no conflicts of interest to report. Mark Flasar participates in advisory boards for Janssen and Prometheus Labs. Jay Lin is an employee of Novosys Health, which received payment from AbbVie for this research analysis. Melissa Lingohr-Smith is an employee of Novosys Health, which received payment from AbbVie for this research analysis. Martha Skup is an employee of AbbVie and may own stock or stock options. Song Wang is a former employee of AbbVie and may own stock or stock options. Jingdong Chao is a former Employee of AbbVie and may own stock or stock options. Raymond Cross receives consulting fees from/for AbbVie; participates in advisory boards for AbbVie, Janssen, Pfizer, and Takeda; and has a research grant with AbbVie.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Seema A. Patil
    • 1
    • 2
  • Mark H. Flasar
    • 3
  • Jay Lin
    • 4
  • Melissa Lingohr-Smith
    • 4
  • Martha Skup
    • 5
  • Song Wang
    • 5
  • Jingdong Chao
    • 5
    • 6
  • Raymond K. Cross
    • 1
    Email author
  1. 1.University of MarylandBaltimoreUSA
  2. 2.Veterans Affairs, Maryland Health Care SystemBaltimoreUSA
  3. 3.Anne Arundel Gastroenterology AssociatesAnnapolisUSA
  4. 4.Novosys HealthFlemingtonUSA
  5. 5.AbbVie, IncNorth ChicagoUSA
  6. 6.White PlainsUSA

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