P0679Significant disparities in biologics use in IBD patients from non-urban areas in India- a single centre study

Background Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition requiring long-term care, monitoring and use of healthcare resources. The significant increase of disease burden in newly industrialized nations is a major concern. Assessing health-economics of IBD is critical for resource allocation and policymaking. We aimed to evaluate direct annual costs of management that patients bear for both Ulcerative Colitis (UC) and Crohn’s disease (CD), whilst identifying disparities among patient subgroups. Methods A retrospective review of 135 patients diagnosed with IBD at a tertiary centre in India between Jan 2023 and Aug 2025 was done using EMR. All relevant baseline data was recorded. Patients’ city of residence was classified into Tier 1–3 (1), a widely accepted classification for governance in India. The approximate mean annual per capita income is estimated to be ₹573,836.14 in Tier-1 cities and ₹440,773.00 in Tier-2/3 cities. (€1 Euro = ₹102.64 INR) The annual cost burden for each patient was categorized into long term medications, acute flare-ups, supplements, and endoscopy costs. Comparisons of total and component-wise costs across disease and subgroups were performed using independent-sample t-tests for normally distributed variables and the Mann–Whitney U test for non-parametric data. Results Of 135 patients (median age 38y; Male = 64.4%), 72 had UC and 63 had CD. The median (IQR) annual cost burden per patient was ₹29,351 (18,544–495,81). Biologics were administered to 39 patients (28.9%), while 96 (71.1%) received conventional therapy. Expectedly, a higher proportion of biologic users had CD (79.5%) compared to UC (20.5%), and there was wide variation in expenses between biologic and non-biologic users [Median (IQR): ₹703,551.00 (18,850.5–43,329) vs ₹23,700.50 (17,544–702,801), (p < 0.001)]. Correspondingly, CD resulted in higher overall annual costs than those with UC. (Table 1A+2) When stratified by place of residence, biologic users were more likely from Tier-1 cities (56.4% vs 33.3%; p = 0.013). The cost burden was substantial, with biologic costs equaling 121.4% of median annual income in Tier-1 cities and rising to 175.3% in Tier-2/3 cities (Table 1B). Conclusion A substantial proportion of patients with CD required biologics across both residence groups, reflecting severe disease. Biologic use was more common in Tier-1 cities than in Tier-2/3 regions. The financial burden of biologics far exceeded the annual per capita income, likely creating marked financial deficit for patients especially those from Tier-2/3 cities. These findings highlight an urgent need for stakeholders to address costs and ensure equitable access to care. Reference: 1. Government of India, Ministry of Finance, Department of Expenditure. (2008). Recommendations of the Sixth Central Pay Commission: Decision of Government relating to grant of allowances (Office Memorandum). https://dispur.nic.in/sixthpay/sixth-pay-allowances.pdf Conflict of interest: Dr. Chamarthi, Govind Datta: No conflict of interest Ashok S, Shalini: none Reddyvari, Kiran: No conflict of interest Gopalakrishnan, Gayathri: No conflict of interest Kalachannegowda, Nandish Hullenahalli: No conflict of interest Kumar N, Sunil: No conflict of interest Kumar B. R, Vinay: No conflict of interest Shankar, Sahana: No conflict of interest Rao, Aditi: No conflict of interest Paul, Anju: No conflict of interest Shivaji, Uday Nagesh: No conflict of interest