The Hidden Costs of Inflammatory Bowel Disease Care: A Time and Motion Study of Hospital-Based Biologic Infusions

Background:
Inflammatory bowel disease (IBD) is a chronic condition requiring costly biologic therapies often administered intravenously. While the direct medication costs of biologics are well-documented, the associated resource utilization and expenses within infusion units remain largely unexplored. Existing research on infusion unit costs is limited by small sample sizes and methodological flaws. This study aims to comprehensively evaluate the economic burden of IV biologic infusions for IBD by examining patient and healthcare personnel time, medical supplies, and indirect costs.
Methods:
A prospective observational study was conducted at a single tertiary referral center. Using a time and motion methodology, data were collected on patient and healthcare personnel activities during IV biologic infusions. Costs were calculated based on personnel salaries, medical supplies, and productivity loss.
Results:
A total of 146 patients were included, with the majority having Crohn&#x2019;s disease (76.6%). Infliximab was the most commonly used biologic (70.5%), followed by vedolizumab (26.2%) and ustekinumab (3.4%). Infliximab infusions required significantly more time for both nurses and patients compared to vedolizumab and ustekinumab. The average infusion times were infliximab: 95 (SD&#xb1; 27) minutes, vedolizumab: 35 (SD&#xb1; 7) minutes, ustekinumab: 60 (SD&#xb1; 5) minutes. Nurse time was also significantly higher for infliximab, averaging 253 (SD&#xb1;64) minutes compared to 60 (SD&#xb1; 18) minutes for vedolizumab and 86 (SD&#xb1; 1) minutes for ustekinumab. Pharmacy and physician times did not differ significantly between the biologics. In terms of costs, infliximab was significantly more expensive than vedolizumab (<italic>P&#x3c;</italic> 0.001) and ustekinumab (<italic>P&#x3c;</italic> 0.001). This was primarily due to higher nurse costs associated with infliximab. The average total costs per infusion were infliximab: 829.48 SAR (Saudi Arabia Riyal), vedolizumab: 598.01 SAR, ustekinumab: 490.31 SAR. While pharmacy and physician costs did not differ significantly between the biologics, the overall cost differences were primarily driven by the higher nurse costs associated with infliximab. Nurse costs were significantly higher for infliximab compared to vedolizumab (<italic>P&#x3c;</italic> 0.001) and ustekinumab (<italic>P&#x3c;</italic> 0.001). The average nurse costs per infusion were infliximab: 225.17 SAR, vedolizumab: 53.55 SAR, ustekinumab: 76.54 SAR. Additionally, patient-related factors contributed to the overall treatment burden. A total of 36 patients (24.8%) were accompanied by someone during the infusion process. Of these, 15 (41.7%) had to take time off work. Thirteen patients (9%) required a taxi, while 44 (30.3%) came from outside the city, with 8 (5.5%) staying in a hotel and 6 (4.1%) needing an airplane ticket. These factors represent additional indirect costs associated with the treatment.
Conclusions:
This study revealed that the economic burden of hospital-based biologic infusions for IBD extends beyond medication costs. Nurse time was a significant cost driver, particularly for infliximab. While pharmacy and physician costs did not vary significantly, the overall cost of infliximab was notably higher than vedolizumab and ustekinumab. These findings underscore the importance of considering resource utilization when evaluating the cost-effectiveness of biologic treatments for IBD.