Probability of Response as Defined by a Clinical Decision Support Tool Is Associated With Lower Healthcare Resource Utilization in Vedolizumab-Treated Patients With Crohn's Disease.

ABSTRACT

Background: A previously developed clinical decision support tool (CDST) identified patients with Crohn's disease (CD) most likely to respond to vedolizumab. This study evaluated the ability of the CDST to predict real-world healthcare resource utilization (HRU). Methods: The Optum and Truven healthcare databases were searched for patients with CD treated with vedolizumab (Optum, n = 358; Truven, n = 1445) or an anti-tumor necrosis factor (TNF) agent (Optum, n = 814). Patients were stratified using the 5-variable (prior bowel surgery, prior fistulizing disease, prior anti-TNF exposure, albumin, C-reactive protein) and a new modified 3-variable (without laboratory data) CDST. Annualized expenditures and HRU were compared with both CDSTs across response probability groups for a 12-month period. Results: In the Optum data set, the 5- and 3-variable CDSTs identified lower rates of surgery or hospitalization in CD patients with higher probability of vedolizumab response. Per-patient total costs were 2.5 times lower for CD patients with high versus low probability of vedolizumab response ($12 943 vs $32 931). The 5- and 3-variable CDSTs did not consistently identify anti-TNF-treated CD patients with higher HRU. The 3-variable CDST also identified vedolizumab-treated CD patients with higher probability of response and lower probability for surgery or hospitalization in the Truven data set. Conclusions: The 5-variable CDST identified CD patients treated with vedolizumab, but not an anti-TNF agent, at higher risk for HRU. The 3-variable CDST offers similar performance but more flexibility by removing laboratory data requirements for prediction. These validated CDSTs can be integrated into population health monitoring algorithms using real-world data.