Comparison of Real-World Healthcare Resource Utilization Among Advanced Therapy-Experienced Patients With Ulcerative Colitis Initiated on Ustekinumab or Vedolizumab

Background: Among patients with ulcerative colitis (UC), prior exposure to biologics or other advanced therapies is associated with reduced response to future therapies, which may lead to higher healthcare resource utilization (HRU). Real-world HRU data among advanced therapy-experienced patients with UC is lacking. This study aimed to compare HRU among patients with UC initiated on ustekinumab, an anti-interleukin 12/23 antibody, or vedolizumab, an anti-integrin biologic. Methods: Adults with UC initiated on ustekinumab or vedolizumab (index date) between 10/21/2019 and 03/02/2022 were selected from the IQVIA PharMetrics® Plus database. Patients were advanced therapy-experienced (i.e., had ≥1 claim for a non-index UC-indicated biologic or advanced therapy agent) in the 12-month baseline period before the index date. Patients with other autoimmune diseases during the baseline period were excluded. Cohorts were balanced on baseline characteristics using inverse probability of treatment weights. HRU outcomes, including all-cause and UC-related number of inpatient (IP) visits and days, emergency department (ED) visits and outpatient (OP) visits, were described during the follow-up period (i.e., index date till earliest of end of data or health plan eligibility) per-100 patients-per-month. Further, all HRU outcomes were compared between the weighted cohorts using weighted Poisson regressions. Results: There were 647 patients in the weighted ustekinumab cohort (mean age: 41.9; 49.1% female) and 1,152 patients in the weighted vedolizumab cohort (mean age: 41.7; 47.0% female). The mean duration of follow-up was 14.9 months for the ustekinumab cohort and 15.7 months for the vedolizumab cohort. During the follow-up period, the ustekinumab cohort had a mean of 1.43 all-cause IP visits and 7.94 all-cause IP days; while the vedolizumab cohort had a mean of 2.06 all-cause IP visits and 15.89 all-cause IP days; the vedolizumab cohort had a 44% higher rate of IP visits (rate ratio [RR]: 1.44; 95% confidence interval [CI]: 1.08-2.07; p-value: 0.012) and double the rate of IP days (RR: 2.00; 95% CI: 1.34-3.28, p-value: < 0.001). Further, the mean number of all-cause ED visits was 5.84 for the ustekinumab cohort and 7.47 in the vedolizumab cohort; the vedolizumab cohort had 28% higher rate ED visits (RR: 1.28; 95% CI: 1.01-1.64, p-value: 0.048). Moreover, the mean number of all-cause OP visits was 185.73 for the ustekinumab cohort and 224.59 for the vedolizumab cohort; the vedolizumab cohort had 21% higher rate of OP visits (RR: 1.21; 95% CI: 1.07-1.35, p-value: 0.004). Similar trends were observed for UC-related HRU across both cohorts. Conclusions: Advanced therapy-experienced patients with UC treated with ustekinumab had significantly lower healthcare resource utilization than patients treated with vedolizumab. These results may help inform healthcare providers in managing patients with prior advanced UC therapies.