(Reuters Health) – Patients with inflammatory bowel disease are no more likely to have treatment-related urgent care visits when they receive home infusions instead of conventional administration of their medications, a recent study suggests.
Researchers examined insurance claims data for 11,892 people receiving conventional infliximab and 1,573 individuals who administered the medication via home infusions. They also analyzed claims data for 438 conventional vedolizumab patients as well as 138 people who received home infusions.
With home infusions, 2.9% of patients on infliximab and 1.5% of patients on vedolizumab had an urgent care or emergency department visit within two days following their infusions, as compared with 3.1% of patients on infliximab and 2.5% of patients on vedolizumab who received conventional infusions, the study team reports in Crohn’s & Colitis 360.
“While I personally continue to struggle with coordinating home infusions, getting monitoring labs done appropriately, and communicating with home infusion nurses, I can’t argue with numbers that suggest that there aren’t adverse reactions with home infusion that are significant enough to result in urgent or emergent care utilization,” said lead study author Dr. Bharati Kochar, a gastroenterologist at Massachusetts General Hospital in Boston and an instructor at Harvard Medical School.
“Urgent and emergent care utilization is obviously only one marker of safety; however, it is certainly one of the more pertinent markers of safety,” Dr. Kochar said by email.
Patients were significantly more likely to have an urgent care or emergency department visit within two days following home infusions if they had a Charleston comorbidity index score of greater than 0 (odds ratio 1.95) or if they had Medicaid as their primary source of insurance (OR 3.01).
“As with all things in medicine, patients with fewer resources and those who are medically more complicated are at higher risk for complications and the etiologies of these complications are most often multi-factorial,” Dr. Kochar said.
For infliximab, median charges for infusions were similar when patients had conventional infusions ($5,981) and home infusions ($6,000).
However, median charges were lower for infusions with vedolizumab when patients had conventional therapy ($7,500) than with home treatment ($10,700).
Researchers also separately surveyed 644 patients who received biologic infusions. This included 137 people who had infusions at a clinic, 440 people who had infusions at an infusion center, and 56 people who had home infusions.
More than half of patients who didn’t receive home infusions (54%) said they would like to do so if it was an option for them. Some of the most common reasons they cited for wanting home infusions included the potential to save time (39%), the comfort of being at home (36%), and not requiring transportation (11%).
A sizable minority of people who didn’t get home infusions (28%) said they wouldn’t want the option. Most often, people who didn’t want home infusions cited concerns about getting intravenous access (32%), safety (15%), and privacy (15%).
Those who did receive home infusions most often (59%) said it was less disruptive to their schedules. In addition, 45% said their insurance company required it.
One limitation of the study is that the administrative claims data used for the safety analysis don’t allow for assessment of disease activity or other individual patient characteristics that might influence infusion outcomes, the authors note. Another is that the researchers only had data on charges, not on actual costs incurred.
SOURCE: https://bit.ly/3ElR13A Crohn’s & Colitis 360, online September 1, 2021.
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