P1441 - Healthcare Costs Before and After the Initiation of Prucalopride Treatment: A Real World Study in Patients With Constipation in the U.S.

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Paul Feuerstadt, MD

Yale University School of Medicine and PACT-Gastroenterology Center
Westport, CT, United States

Paul Feuerstadt, MD¹, Mei Lu, MSc, MD², Emi Terasawa, PhD³, Brian Terreri, PharmD, MBA⁴, Shawn Du, PhD³, Rajeev Ayyagari, PhD⁵, Brooks D. Cash, MD, FACG⁶, Anthony Lembo, MD⁷, Baha Moshiree, MD⁸, Philip Schoenfeld, MD, MSEd, MSc (Epi), FACG⁹, Mena Boules, MD⁴, Linda Nguyen, MD¹⁰
¹Yale University School of Medicine and PACT-Gastroenterology Center, Hamden, CT; ²Takeda Development Center Americas, Inc., Lexington, MA; ³Analysis Group, Inc., New York, NY; ⁴Takeda Pharmaceuticals USA, Inc., Lexington, MA; ⁵Analysis Group, Inc., Boston, MA; ⁶University of Texas Health Science Center at Houston, Houston, TX; ⁷Beth Israel Deaconess Medical Center, Boston, MA; ⁸Atrium Health, Charlotte, NC; ⁹John D. Dingell VA Medical Center, Redwood City, CA; ¹⁰Stanford University, Redwood City, CA

Introduction: Prucalopride is a selective high-affinity serotonin type-4 receptor agonist approved for the treatment of chronic idiopathic constipation in adults. Healthcare costs before and after the initiation of prucalopride in the USA have not been studied.

Methods: An observational retrospective cohort analysis of data from the MarketScan Commercial Claims and Encounters database (2015–Q2 2020) was performed for patients aged 18–64 years with ≥1 prescription filled for prucalopride and a diagnosis of constipation based on ICD-10 codes, who were continuously enrolled from ≥6 months before (baseline) to ≥6 months after (study period) prucalopride initiation. Patients were excluded if they had a diagnosis of irritable bowel syndrome with constipation, drug-induced constipation or post-operative ileus, opioid use or had a capitated health plan. Healthcare costs were estimated from a third-party payer perspective and adjusted to 2020 US dollars and included pharmacy costs and medical costs (from inpatient, emergency room and outpatient encounters). All-cause and constipation-related healthcare costs (identified using ICD-10 codes) were compared at baseline and during the study period using a Wilcoxon signed-rank test.

Results: A total of 564 patients were included in the analysis. There was a reduction in all-cause medical costs in the study period versus baseline (total $11 679 vs $13 393; p< 0.001; Image). Total all-cause healthcare costs were numerically lower during the study period than baseline ($20 263 vs $21 145); however, this difference was not statistically significant. There was a significant reduction in constipation-related medical costs in the study period versus baseline (total $580 vs $876; p< 0.001; Image), primarily driven by reduced constipation-related outpatient costs ($385 vs $550; p< 0.001). Constipation-related pharmacy costs increased over the study period; however, when the cost of prucalopride was excluded, total constipation-related healthcare costs decreased from $1497 (SD, $2732) at baseline to $949 (SD, $2913) in the study period (p< 0.001)

Discussion: Although pharmacy costs increased, constipation-related and all-cause medical costs were both significantly reduced after the initiation of prucalopride, mostly due to reduction of outpatient costs. As healthcare costs typically increase when a new treatment is initiated, additional studies with a longer follow-up are warranted to further investigate the cost impact of prucalopride.

Figure: Image. Mean all-cause (A) and constipation-related (B) healthcare costs in the 6 months before (baseline) and 6 months after (study period) the initiation of prucalopride treatment in patients aged 18–64 years without a capitated health plan (N=564)

*Significant difference at the 5% confidence level.
Medical costs are defined as the sum of the medical costs at different settings (ER, inpatient, outpatient office/clinic/urgent care, outpatient hospital/surgical center and other outpatient setting). Outpatient costs are the sum of the costs presented for outpatient/office/clinic/urgent care, outpatient hospital/surgical center and outpatient other (i.e., laboratory tests and outpatient home health services). Total healthcare costs are the sum of the medical costs at all settings and pharmacy costs.
Constipation-related medical costs are defined as costs associated with healthcare resource use for which a diagnosis code for constipation was found in one of the first three positions for the corresponding claim. Constipation-related pharmacy costs were defined as costs associated with constipation-related treatments.
ER, emergency room.

Disclosures:

Paul Feuerstadt: Ferring/Rebiotix – Consultant, Speaker's Bureau. Merck and Co. – Consultant, Speaker's Bureau. SERES Therapeutics – Consultant, Speaker's Bureau. Takeda Pharmaceuticals – Advisory Committee/Board Member.

Mei Lu: Takeda Development Center Americas, Inc. – Employee. Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds).

Emi Terasawa: Analysis Group Inc. – Employee. Takeda Pharmaceuticals USA, Inc. – Grant/Research Support.

Brian Terreri: Takeda Development Center Americas, Inc. – Employee. Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds).

Shawn Du: Analysis Group Inc. – Employee. Takeda Pharmaceuticals USA, Inc. – Grant/Research Support.

Rajeev Ayyagari: Analysis Group Inc. – Employee. Takeda Pharmaceuticals USA, Inc. – Grant/Research Support.

Brooks Cash: Takeda Pharmaceuticals – Consultant, Speaker's Bureau.

Anthony Lembo: Aeon – Consultant. Allakos – Consultant. Arena – Consultant. Bayer – Consultant. Bellatrix – Consultant. Bristol Myer Squibb – Stockholder/Ownership Interest (excluding diversified mutual funds). Gemilli biotech – Consultant. Ironwood – Consultant. Johnson and Johnson – Stockholder/Ownership Interest (excluding diversified mutual funds). Mylan – Consultant. OrphoMED – Consultant. Shire, a Takeda company – Consultant. Takeda – Consultant. Vibrant – Consultant.

Baha Moshiree: AbbVie Pharmaceuticals – Advisory Committee/Board Member, Grant/Research Support. Allergan – Advisory Committee/Board Member, Grant/Research Support. Alnylam Pharmaceuticals – Advisory Committee/Board Member, Consultant, Grant/Research Support, Speaker's Bureau. Medotronic – Advisory Committee/Board Member, Grant/Research Support. Progenity – Advisory Committee/Board Member, Grant/Research Support. Salix/Bausch Pharmaceuticals – Advisory Committee/Board Member, Consultant, Grant/Research Support, Speaker's Bureau. Takeda Pharmaceuticals – Advisory Committee/Board Member, Consultant, Grant/Research Support, Speaker's Bureau. University of Miami/Atrium Health – Patent Holder.

Philip Schoenfeld: AbbVie Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speaker's Bureau. Allergan – Advisory Committee/Board Member, Consultant, Speaker's Bureau. Alnylam Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speaker's Bureau. Ironwood – Advisory Committee/Board Member, Consultant, Speaker's Bureau. Phathom – Advisory Committee/Board Member, Consultant, Speaker's Bureau. Salix Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speaker's Bureau. Takeda Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speaker's Bureau.

Mena Boules: Takeda Development Center Americas, Inc. – Employee. Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds).

Linda Nguyen: Alnylam – Consultant. Bold Health – Grant/Research Support. Eli Lilly – Consultant. Gamelli Biotech – Advisory Committee/Board Member. Ironwood – Consultant. Neurogastx – Consultant. Pendulum – Consultant. Phathom – Consultant. Takeda Pharmaceuticals – Consultant. Vanda – Grant/Research Support.