Leveraging Nationwide Health and Insurance Records to Track Biologic Drug Diffusion in IBD: A 20-Year Real-World Study From Israel
Author(s)
Ruslan Sergienko, BEng, MHA1, Doron Schwartz, MD, MHA2, Ganit Goren, PhD3, Michael Friger, PhD4, Alon Monsonego, PhD5, Orly Sarid, PhD3, Vered Slonim-Nevo, PhD3, Shmuel Odes, MD6, Dan Greenberg, PhD1.
1Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 2Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer-Sheva, Israel, 3The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 4Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 5The Shraga Segal Department of Microbiology, Immunology, and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 6Division of Internal Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
1Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 2Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer-Sheva, Israel, 3The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 4Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 5The Shraga Segal Department of Microbiology, Immunology, and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 6Division of Internal Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
OBJECTIVES: To examine how nationwide electronic health and insurance records can be used to track real-world adoption and diffusion of biologic drugs (biologics) in inflammatory bowel disease (IBD) patients across Israel’s universal healthcare system.
METHODS: This retrospective cohort study utilized administrative and clinical data from all four Israeli health maintenance organizations (HMOs), linked through a validated national IBD registry (epi-IIRN cohort). The cohort included 49,267 patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) between 1998 and 2018. Biologics initiation was defined by pharmacy dispensation records; diffusion patterns were assessed using survival analysis and Cox models, with stratification by demographic and clinical variables.
RESULTS: Biologics were initiated in 34% of CD and 11% of UC patients. Pediatric-onset and high-risk patients (e.g., surgery or corticosteroid users) adopted biologics earlier. Diffusion curves followed expected S-shapes, especially for infliximab. Uptake of newer biologics accelerated following market entry. The data system enabled near-complete capture of IBD cases, treatment histories, and longitudinal outcomes. Multivariable analysis identified year of diagnosis, age, and clinical severity as key predictors of uptake. Data completeness and integration across organizations enabled robust tracking of treatment trends and disparities.
CONCLUSIONS: This study demonstrates the potential of integrated national health and insurance records to monitor long-term real-world therapeutic patterns. The Israeli IBD data infrastructure enabled comprehensive, population-based analysis of biologic drugs adoption and diffusion, offering a replicable model for health systems aiming to leverage RWD for treatment monitoring, equity assessment, and policy planning.
METHODS: This retrospective cohort study utilized administrative and clinical data from all four Israeli health maintenance organizations (HMOs), linked through a validated national IBD registry (epi-IIRN cohort). The cohort included 49,267 patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) between 1998 and 2018. Biologics initiation was defined by pharmacy dispensation records; diffusion patterns were assessed using survival analysis and Cox models, with stratification by demographic and clinical variables.
RESULTS: Biologics were initiated in 34% of CD and 11% of UC patients. Pediatric-onset and high-risk patients (e.g., surgery or corticosteroid users) adopted biologics earlier. Diffusion curves followed expected S-shapes, especially for infliximab. Uptake of newer biologics accelerated following market entry. The data system enabled near-complete capture of IBD cases, treatment histories, and longitudinal outcomes. Multivariable analysis identified year of diagnosis, age, and clinical severity as key predictors of uptake. Data completeness and integration across organizations enabled robust tracking of treatment trends and disparities.
CONCLUSIONS: This study demonstrates the potential of integrated national health and insurance records to monitor long-term real-world therapeutic patterns. The Israeli IBD data infrastructure enabled comprehensive, population-based analysis of biologic drugs adoption and diffusion, offering a replicable model for health systems aiming to leverage RWD for treatment monitoring, equity assessment, and policy planning.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD281
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Gastrointestinal Disorders