TREATMENT PATTERNS AND RESOURCE COSTS ASSOCIATED WITH THE MANAGEMENT OF PRIMARY BILIARY CIRRHOSIS

OBJECTIVES: The purpose of this study was to describe treatment patterns, resource utilization and costs associated with the management of PBC in a real life setting. METHODS: This study was performed using data from the Quebec public drug plan database (RAMQ). Patients with at least two diagnoses of biliary cirrhosis and a prescription of ursodiol between January 2008 and May 2015, and with enrolment in the drug plan during the study period were selected. A control group of non-PBC patients matched for age group and gender was selected from a random sample of individuals covered by the RAMQ in a 1:10 ratio. RESULTS: A total of 158 PBC patients and a control group of 1,580 matched non-PBC patients were included in this study. The average age was 63.2 years (SD=12.7) and 84.2% of PBC patients were women. The treatment with ursodiol had an average duration of 4.1 years (SD=2.5) and the majority of users did not use other medications before (91.8%), during (57.0%) and after (88.6%) ursodiol treatment. Prednisone was the treatment most often used in concomitance with ursodiol (22.2%). The 1-year rate of ursodiol discontinuation was 10.8% (95% CI:5.9-15.7) and the 4-year rate was 22.1% (95% CI:15.2-29.0). The mean total health care cost per patient per year was significantly higher among PBC patients than non-PBC patients (17,283$CAN; SD=35,046 vs. 3,970$CAN; SD=6,426, mean difference=13,313$CAN). The primary driver of PBC patients' total health care cost was the hospitalization cost (8,809$CAN) while the prescription drug cost was 5,365$CAN and the physicians' visit and procedure cost was 2,855$CAN. The mean number of hospitalization per year was 0.9 (mean duration=8.9 days), with 73.4% of PBC patients with at least one hospitalization. CONCLUSIONS: Total health care costs incurred by PBC patients in comparison with non-PBC patients confirm the significant economic burden associated with this condition.