{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T08:03:42Z","timestamp":1790496222536,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T00:00:00Z","timestamp":1560816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100007658","name":"Crohn\u2019s and Colitis Canada","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007658","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Helmsley Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Anti\u2013tumor necrosis factor (anti-TNF) drugs are highly effective in the treatment of moderate-to-severe Crohn\u2019s disease (CD) and ulcerative colitis (UC), but they are very costly. Due to their effectiveness, they could potentially reduce future health care spending on other medical therapies, hospitalization, and surgery. The impact of downstream costs has not previously been quantified in a real-world population-based setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used the University of Manitoba IBD Database to identify all persons in a Canadian province with CD or UC who received anti-TNF therapy between 2004 and 2016. All inpatient, outpatient, and drug costs were enumerated both in the year before anti-TNF initiation and for up to 5 years after anti-TNF initiation. Costs before and after anti-TNF initiation were compared, and multivariate linear regression analyses were performed to look for predictors of higher costs after anti-TNF initiation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 928 people with IBD (676 CD, 252 UC) were included for analyses. The median cost of health care in the year before anti-TNF therapy was $4698 for CD vs $6364 for UC. The median cost rose to $39,749 and $49,327, respectively, in the year after anti-TNF initiation, and to $210,956 and $245,260 in the 5 years after initiation for continuous anti-TNF users. Inpatient and outpatient costs decreased in the year after anti-TNF initiation by 12% and 7%, respectively, when excluding the cost of anti-TNFs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Direct health care expenditures markedly increase after anti-TNF initiation and continue to stay elevated over pre-initiation costs for up to 5 years, with only small reductions in the direct costs of non-drug-related health care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ibd\/izz063","type":"journal-article","created":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T14:10:01Z","timestamp":1560867001000},"page":"1718-1728","source":"Crossref","is-referenced-by-count":34,"title":["The Effect of Initiation of Anti-TNF Therapy on the Subsequent Direct Health Care Costs of Inflammatory Bowel Disease"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4366-9076","authenticated-orcid":false,"given":"Laura E","family":"Targownik","sequence":"first","affiliation":[{"name":"Section of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric I","family":"Benchimol","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children\u2019s Hospital of Eastern Ontario, Ottawa, ON, Canada"},{"name":"Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada"},{"name":"Institute for Clinical Evaluative Sciences, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Witt","sequence":"additional","affiliation":[{"name":"Department of Economics, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles N","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harminder","family":"Singh","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada"},{"name":"Department of Community Health Sciences, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Lix","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aruni","family":"Tennakoon","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Avi\u00f1a","family":"Zubieta","sequence":"additional","affiliation":[{"name":"Arthritis Research Centre, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Coward","sequence":"additional","affiliation":[{"name":"Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of internal Medicine, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Kuenzig","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital IBD Centre, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay K","family":"Murthy","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital IBD Centre, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey C","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Ontario"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Nicol\u00e1s","family":"Pe\u00f1a-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,18]]},"reference":[{"key":"2019091808541702700_CIT0001","doi-asserted-by":"crossref","first-page":"j2505","DOI":"10.1136\/bmj.j2505","article-title":"Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel 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