Biologic therapy for IBD patients through a financial assistance program could have superior outcomes

Patients with inflammatory bowel diseases (IBD) who required treatment with biologic therapies and were enrolled in a financial assistance program were less likely to need surgery after starting medication than those not enrolled in a program, a study by UT Southwestern researchers found.

There are gaps in care for patients with IBD. Our project pointed out that providing biologic therapy for IBD patients through a financial assistance program would have superior outcomes compared to patients with delays in receiving treatment."

Moheb Boktor, M.D., Associate Professor of Internal Medicine in the Division of Digestive and Liver Diseases at UTSW and Lead Author

Low socioeconomic status is a well-known risk factor for poor health outcomes and higher health care resource utilization in numerous chronic diseases. Financial assistance programs are designed to improve health care for patients of low socioeconomic status through reduced costs for medical services.

For patients with IBD, such as Crohn's disease or ulcerative colitis, delays in treatment can significantly worsen their condition, leading to increased long-term morbidity and health care costs. Therefore, access to affordable, quality health care can have significant effects on overall outcomes.

The study, published in Pathophysiology, used medical records of indigent IBD patients treated at Parkland Health to evaluate the impact of financial assistance programs on health care outcomes and resource utilization. The "safety-net" hospital's program provides indigent patients access to medication at deep discounts without the need for authorization from medical insurance companies.

Adult patients who started a new biologic medication for treatment of IBD between January 2010 and January 2019 were included in the study. The researchers classified the patients by whether they were enrolled in the financial assistance program or covered by private or government insurance.

Compared to patients covered by insurance, patients enrolled in the program were less likely to require surgery. This was consistent even when accounting for variables such as age, sex, race, and complexity/severity of disease.

Interestingly, patients receiving financial assistance also underwent more imaging studies before needing surgery than nonprogram patients. The researchers believe this may be due in part to easier access to the required scans because of insurance authorization and copayments not being required. Access to imaging may explain the need for fewer surgeries, as these studies may be used to adjust treatment regimens. However, additional studies are needed to fully explore these possibilities as well as whether financial assistance program enrollment reduces overall disease severity.

Providing therapy without interruption for IBD minimizes complications and achieves a normal quality of life for patients, Dr. Boktor said. Programs between health care systems and pharmaceutical companies can potentially close such gaps in health care management for patients with IBD and other chronic diseases.

Other UT Southwestern researchers who contributed to this study include Phillip Gu, Andrew Gilman, Christopher Chang, David I. Fudman, and Ezra Burstein. Elizabeth Moss of the Ambulatory Care Pharmacy at Parkland Health also contributed.