OBJECTIVES : In France, the reimbursement of hospital drugs according to the indications was implemented: in addition to diagnosis-related group (DRG) tariffs, included into DRG tariffs or no refund. Until January 2017, vedolizumab was refunded from 3rd line in the ulcerative colitis (UC) and in Crohn's disease (CD) in addition to DRG tariffs and was not refunded for 2rd line. Since January 2017, the CD was included into DRG tariffs (€40 estimated drugs cost) and the UC was still refunded in addition to DRG tariffs (€1529). An exceptional financing of €3 million distributed among the French hospitals was implemented for patients initiated in CD before January 2017. This study assesses the impacts of this change on both the prescriptions alterations and the reimbursements for the vedolizumab into 37 Publics Hospitals of Paris (APHP).

METHODS : The data collected were: i) consumptions/expenditures in vedolizumab from 04/2016 to 09/2017; ii) reimbursements from 01/2017 to 09/2017 with the PMSI (French Hospital National Database) and ICD10 diagnosis.

RESULTS : From 01/2017 to 09/2017, 15/37 hospitals have used vedolizumab with four main hospitals (61% of consumption). 1936 vials (€3,594,677) were prescribed (+22% compared with the 9 previous months) including 47% (912 vials; €1,712,504) for the CD (+18%). A downturn of -29% in the CD was observed between 01/2017 from 09/2017. 1901 vials (€3,419,318€) were reimbursed including €1,693,360 for the CD (46%). The prescription for the CD in the hospitals of APHP has represented 56% of the national exceptional financing of €3 million.

CONCLUSIONS : The CD still accounts for a large share of prescriptions. The decrease has begun with acceleration since June 2017 with the switches from vedolizumab to ustekinumab (alternative reimbursed in addition to DRG tariffs). Nevertheless, will the hospitals be able to continue to pay for the CD patients in failure of ustekinumab but responders to vedolizumab?