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01.12.2013 | Original Article

Health Care Costs of Complex Perianal Fistula in Crohn’s Disease

verfasst von: M. Chaparro, C. Zanotti, P. Burgueño, I. Vera, F. Bermejo, I. Marín-Jiménez, C. Yela, P. López, M. D. Martín, C. Taxonera, B. Botella, R. Pajares, A. Ponferrada, M. Calvo, A. Algaba, L. Pérez, B. Casis, J. Maté, J. Orofino, N. Lara, M. García-Losa, X. Badia, J. P. Gisbert

Erschienen in: Digestive Diseases and Sciences | Ausgabe 12/2013

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Abstract

Aim

To evaluate the use of health care resources and the associated costs of complex perianal Crohn’s disease (CD) from the National Health System perspective.

Methods

We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review.

Results

We recorded 527 treatments: 73.1 % pharmacological (32.3 % antibiotic, 20.5 % immunomodulator, 20.3 % biological) and 26.9 % surgical. Mean annual global cost was €8,289/patient, 75.3 % (€6,242) of which was accounted for by pharmacological treatments (€13.44 antibiotics; €1,136 immunomodulators; €5,093 biological agents), 12.4 % (€1,027) by hospitalizations and surgery, 7.7 % (€640) by medical visits, 4.2 % (€350) by laboratory/diagnostic tests, and 0.4 % (€30) by emergency department visits.

Conclusions

Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.
Literatur
1.
Zurück zum Zitat Jaisson-Hot I, Flourie B, Descos L, et al. Management for severe Crohn’s disease: a lifetime cost-utility analysis. Int J Technol Assess Health Care. 2004;20:274–279.PubMedCrossRef Jaisson-Hot I, Flourie B, Descos L, et al. Management for severe Crohn’s disease: a lifetime cost-utility analysis. Int J Technol Assess Health Care. 2004;20:274–279.PubMedCrossRef
2.
Zurück zum Zitat Juan J, Estiarte R, Colome E, et al. Burden of illness of Crohn’s disease in Spain. Dig Liver Dis. 2003;35:853–861.PubMedCrossRef Juan J, Estiarte R, Colome E, et al. Burden of illness of Crohn’s disease in Spain. Dig Liver Dis. 2003;35:853–861.PubMedCrossRef
3.
Zurück zum Zitat Silverstein MD, Loftus EV, Sandborn WJ, et al. Clinical course and costs of care for Crohn’s disease: Markov model analysis of a population-based cohort. Gastroenterology. 1999;117:49–57.PubMedCrossRef Silverstein MD, Loftus EV, Sandborn WJ, et al. Clinical course and costs of care for Crohn’s disease: Markov model analysis of a population-based cohort. Gastroenterology. 1999;117:49–57.PubMedCrossRef
4.
Zurück zum Zitat Hay AR, Hay JW. Inflammatory bowel disease: medical cost algorithms. J Clin Gastroenterol. 1992;14:318–327.PubMedCrossRef Hay AR, Hay JW. Inflammatory bowel disease: medical cost algorithms. J Clin Gastroenterol. 1992;14:318–327.PubMedCrossRef
5.
Zurück zum Zitat Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992;14:309–317.PubMedCrossRef Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992;14:309–317.PubMedCrossRef
6.
Zurück zum Zitat Feagan BG, Vreeland MG, Larson LR, et al. Annual cost of care for Crohn’s disease: a payor perspective. Am J Gastroenterol. 2000;95:1955–1960.PubMedCrossRef Feagan BG, Vreeland MG, Larson LR, et al. Annual cost of care for Crohn’s disease: a payor perspective. Am J Gastroenterol. 2000;95:1955–1960.PubMedCrossRef
7.
Zurück zum Zitat Ingle SB, Loftus EV Jr. The natural history of perianal Crohn’s disease. Dig Liver Dis. 2007;39:963–969.PubMedCrossRef Ingle SB, Loftus EV Jr. The natural history of perianal Crohn’s disease. Dig Liver Dis. 2007;39:963–969.PubMedCrossRef
8.
Zurück zum Zitat Figg RE, Church JM. Perineal Crohn’s disease: an indicator of poor prognosis and potential proctectomy. Dis Colon Rectum. 2009;52:646–650.PubMedCrossRef Figg RE, Church JM. Perineal Crohn’s disease: an indicator of poor prognosis and potential proctectomy. Dis Colon Rectum. 2009;52:646–650.PubMedCrossRef
9.
Zurück zum Zitat Cohen RD, Waters HC, Tang B, et al. Effects of fistula on healthcare costs and utilization for patients with Crohn’s disease treated in a managed care environment. Inflamm Bowel Dis. 2008;14:1707–1714.PubMedCrossRef Cohen RD, Waters HC, Tang B, et al. Effects of fistula on healthcare costs and utilization for patients with Crohn’s disease treated in a managed care environment. Inflamm Bowel Dis. 2008;14:1707–1714.PubMedCrossRef
10.
Zurück zum Zitat Lichtenstein GR, Yan S, Bala M, et al. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology. 2005;128:862–869.PubMedCrossRef Lichtenstein GR, Yan S, Bala M, et al. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology. 2005;128:862–869.PubMedCrossRef
11.
Zurück zum Zitat Khaikin M, Chowers Y, Zmora O. Perianal Crohn’s disease. Isr Med Assoc J. 2007;9:163–168.PubMed Khaikin M, Chowers Y, Zmora O. Perianal Crohn’s disease. Isr Med Assoc J. 2007;9:163–168.PubMed
12.
Zurück zum Zitat Colombel JF, Sandborn WJ, Rutgeerts P, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology. 2007;132:52–65.PubMedCrossRef Colombel JF, Sandborn WJ, Rutgeerts P, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology. 2007;132:52–65.PubMedCrossRef
13.
Zurück zum Zitat Bell SJ, Williams AB, Wiesel P, et al. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther. 2003;17:1145–1151.PubMedCrossRef Bell SJ, Williams AB, Wiesel P, et al. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther. 2003;17:1145–1151.PubMedCrossRef
14.
15.
Zurück zum Zitat Blomqvist P, Ekbom A. Inflammatory bowel diseases: health care and costs in Sweden in 1994. Scand J Gastroenterol. 1997;32:1134–1139.PubMedCrossRef Blomqvist P, Ekbom A. Inflammatory bowel diseases: health care and costs in Sweden in 1994. Scand J Gastroenterol. 1997;32:1134–1139.PubMedCrossRef
16.
Zurück zum Zitat Saro C, De la Coba C, Casado MA, et al. Resource use in patients with Crohn’s disease treated with infliximab. Aliment Pharmacol Ther. 2007;26:1313–1323.PubMedCrossRef Saro C, De la Coba C, Casado MA, et al. Resource use in patients with Crohn’s disease treated with infliximab. Aliment Pharmacol Ther. 2007;26:1313–1323.PubMedCrossRef
18.
Zurück zum Zitat Bot PLUS. Base de datos del conocimiento sanitario (CD-ROM). Madrid: Consejo General de Colegios Oficiales de Farmaceúticos; 2010. Bot PLUS. Base de datos del conocimiento sanitario (CD-ROM). Madrid: Consejo General de Colegios Oficiales de Farmaceúticos; 2010.
19.
Zurück zum Zitat Arseneau KO, Cohn SM, Cominelli F, et al. Cost-utility of initial medical management for Crohn’s disease perianal fistulae. Gastroenterology. 2001;120:1640–1656.PubMedCrossRef Arseneau KO, Cohn SM, Cominelli F, et al. Cost-utility of initial medical management for Crohn’s disease perianal fistulae. Gastroenterology. 2001;120:1640–1656.PubMedCrossRef
20.
Zurück zum Zitat Rubenstein JH, Chong RY, Cohen RD. Infliximab decreases resource use among patients with Crohn’s disease. J Clin Gastroenterol. 2002;35:151–156.PubMedCrossRef Rubenstein JH, Chong RY, Cohen RD. Infliximab decreases resource use among patients with Crohn’s disease. J Clin Gastroenterol. 2002;35:151–156.PubMedCrossRef
21.
Zurück zum Zitat Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350:876–885.PubMedCrossRef Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350:876–885.PubMedCrossRef
22.
Zurück zum Zitat Jewell DP, Satsangi J, Lobo A, et al. Infliximab use in Crohn’s disease: impact on health care resources in the UK. Eur J Gastroenterol Hepatol. 2005;17:1047–1052.PubMedCrossRef Jewell DP, Satsangi J, Lobo A, et al. Infliximab use in Crohn’s disease: impact on health care resources in the UK. Eur J Gastroenterol Hepatol. 2005;17:1047–1052.PubMedCrossRef
23.
Zurück zum Zitat Poritz LS, Rowe WA, Koltun WA. Remicade does not abolish the need for surgery in fistulizing Crohn’s disease. Dis Colon Rectum. 2002;45:771–775.PubMedCrossRef Poritz LS, Rowe WA, Koltun WA. Remicade does not abolish the need for surgery in fistulizing Crohn’s disease. Dis Colon Rectum. 2002;45:771–775.PubMedCrossRef
24.
Zurück zum Zitat Domènech E, Hinojosa J, Nos P, et al. Clinical evolution of luminal and perianal Crohn’s disease after inducing remission with infliximab: how long should patients be treated? Aliment Pharmacol Ther. 2005;22:1107–1113.PubMedCrossRef Domènech E, Hinojosa J, Nos P, et al. Clinical evolution of luminal and perianal Crohn’s disease after inducing remission with infliximab: how long should patients be treated? Aliment Pharmacol Ther. 2005;22:1107–1113.PubMedCrossRef
Metadaten
Titel
Health Care Costs of Complex Perianal Fistula in Crohn’s Disease
verfasst von
M. Chaparro
C. Zanotti
P. Burgueño
I. Vera
F. Bermejo
I. Marín-Jiménez
C. Yela
P. López
M. D. Martín
C. Taxonera
B. Botella
R. Pajares
A. Ponferrada
M. Calvo
A. Algaba
L. Pérez
B. Casis
J. Maté
J. Orofino
N. Lara
M. García-Losa
X. Badia
J. P. Gisbert
Publikationsdatum
01.12.2013
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 12/2013
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-013-2830-7

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