Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2017; 8(2): 131-136
Published online May 6, 2017. doi: 10.4292/wjgpt.v8.i2.131
Clinical and economic impact of infliximab one-hour infusion protocol in patients with inflammatory bowel diseases: A multicenter study
Anna Viola, Giuseppe Costantino, Antonino Carlo Privitera, Fabrizio Bossa, Angelo Lauria, Laurino Grossi, Maria Beatrice Principi, Nicola Della Valle, Maria Cappello
Anna Viola, Maria Cappello, Gastroenterology and Hepatology Section, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 90127 Palermo, Italy
Giuseppe Costantino, IBD Unit, Dipartimento di Medicina Interna e Terapia Medica, University of Messina, 98100 Messina, Italy
Antonino Carlo Privitera, IBD and PelvicFloor Unit, Azienda Ospedaliera per l’Emergenza, Ospedale Cannizzaro, 95100 Catania, Italy
Fabrizio Bossa, Gastroenterology Section, Casa Sollievo della Sofferenza, S. Giovanni Rotondo, 75100 Foggia, Italy
Angelo Lauria, Gastroenterology and Endoscopy Unit, A.O. Bianchi-Melacrino-Morelli, 89100 Reggio Calabria, Italy
Laurino Grossi, Fisiopatologia Digestiva Ospedale Spirito Santo, 65100 Pescara, Italy
Maria Beatrice Principi, Gastroenterology Section, 70100 Policlinico Bari, Italy
Nicola Della Valle, Gastroenterologia, 75100 Ospedale di Foggia, Italy
Author contributions: Cappello M conceived the study and coordinated data collection; Viola A and Cappello M retrieved the data from their center, analysed the data and wrote the manuscript which has been approved by all authors; all authors contributed equally to the study design, collection of data and revision of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethical Committee of the Participating Centres.
Informed consent statement: All study participants, or their legal tutor, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interests. None of the authors have any financial or other relations that could lead to a conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Cappello, MD, Gastroenterology and Hepatology Section, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy. marica.cappello61@gmail.com
Telephone: +39-091-6552280 Fax: +39-091-6552156
Received: September 5, 2016
Peer-review started: September 5, 2016
First decision: October 20, 2016
Revised: December 30, 2016
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: May 6, 2017
Processing time: 241 Days and 3.9 Hours
Abstract
AIM

To assess the impact of short infliximab (IFX) infusion on hospital resource utilization and costs.

METHODS

All inflammatory bowel diseases (IBD) patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis. Demographic, clinical and infusion related data were collected. The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity. In addition, indirect patient-related cost savings were evaluated.

RESULTS

One hundred and twenty-five patients were recruited (64 with ulcerative colitis and 61 with Crohn’s disease). Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years (SD: ± 13). Adverse infusion reactions were reported in less than 4% both before and after short infusion. The total number of infusions across the selected centers was of 2501 (30.5% short infusions). In the analyzed cohort, 1143 h were saved (762 in the infusion and 381 in observation phases) through the rapid IFX infusion protocol. This time saving (-15% compared to the standard protocol in infusion phase) represents, from the hospital perspective, an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments. This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use. Hence, an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services. The analysis showed that the short infusion increased the infusion units capacity up to 50% on days when the IFX infusions were scheduled (infusion phase). Furthermore, the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase (observation) leading to a time saving of 10% on average among the analyzed centers. Finally, the short infusion protocol has been demonstrated to lead to indirect cost savings of €138/patient (average -€17.300 on the whole cohort).

CONCLUSION

A short IFX infusion protocol can be considered time and cost saving in comparison to the standard infusion protocol both from the hospital’s perspective, as it contributes to increase infusion units capacity, and the patients’ perspective, as it reduces indirect costs and the impact of treatment on everyday life and work productivity.

Keywords: Infliximab; One-hour infusion; Cost savings; Economic impact; Multicenter study

Core tip: Infliximab (IFX) is a monoclonal antibody anti-tumour necrosis factor used in the treatment of moderate-to-severe inflammatory bowel diseases refractory to conventional therapy. It is usually administered i.v. at a dose of 5 mg/kg as a 2-h infusion. Shortening the infusion protocol to 1 h is equally safe and positively affects quality of life. This paper analyzes the impact of short IFX infusion on hospital resource utilization and costs, both in terms of time saving and increased infusion unit capacity. In addition, we provide evidence of indirect patient-related cost savings.