1
|
Ankersen DV, Weimers P, Marker D, Teglgaard Peters-Lehm C, Bennedsen M, Rosager Hansen M, Olsen J, Elmegaard Madsen M, Burisch J, Munkholm P. Costs of electronic health vs. standard care management of inflammatory bowel disease across three years of follow-up-a Danish register-based study. Scand J Gastroenterol 2021; 56:520-529. [PMID: 33645378 DOI: 10.1080/00365521.2021.1892176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Costs of using eHealth in inflammatory bowel disease (IBD) management has only been assessed for short follow-up periods. The primary aim was to compare the direct costs of eHealth (cases) relative to standard care (matched controls) for IBD during three years of follow-up. METHODS The study design was a retrospective, registry-based follow-up study of patients diagnosed with IBD two years prior, and three years subsequent, to their enrolment in eHealth. Cases were matched 1:4 with controls receiving standard care based on diagnosis, gender, biologics (yes/no) and age (+/- 5 years). RESULTS We identified 116 cases (76 (66%) with ulcerative colitis (UC) and 40 (34%) with Crohn's disease (CD)) and matched them with 433 controls. IBD-related outpatient costs were only significantly higher for cases in the year of their inclusion in eHealth (€2,949 vs. €1,621 per patient, p =.01). Mean IBD-related admission costs tended to fall after enrolment in eHealth, with mean admission costs per patient at year 3 of follow-up of €74 for cases and €383 for controls (p = .02). Linear extrapolation of the reduction in costs beyond year 3 after enrolment in eHealth revealed that eHealth would be cost neutral or saving, relative to standard care, from year 4. CONCLUSION IBD-related outpatient costs in both groups were similar and only significantly higher for cases in the year of their enrolment in eHealth, with admission costs typically falling after a patient's inclusion in eHealth. Estimation revealed eHealth to be cost neutral or saving from year 4.
Collapse
Affiliation(s)
- Dorit Vedel Ankersen
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Petra Weimers
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Dorte Marker
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | | | - Mette Bennedsen
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Malte Rosager Hansen
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | | | | | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| |
Collapse
|
2
|
Wu G, Yang Y, Liu M, Wang Y, Guo Q. Systematic Review and Network Meta-Analysis: Comparative Efficacy and Safety of Biosimilars, Biologics and JAK1 Inhibitors for Active Crohn Disease. Front Pharmacol 2021; 12:655865. [PMID: 33935772 PMCID: PMC8080031 DOI: 10.3389/fphar.2021.655865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Crohn disease (CD) is a chronic inflammatory disease that affects quality of life. There are several drugs available for the treatment of CD, but their relative efficacy is unknown due to a lack of high-quality head-to-head randomized controlled trials. Aim: To perform a mixed comparison of the efficacy and safety of biosimilars, biologics and JAK1 inhibitors for CD. Methods: We searched PubMed, Web of Science, embase and the Cochrane Library for randomized controlled trials (RCTs) up to Dec. 28, 2020. Only RCTs that compared the efficacy or safety of biosimilars, biologics and JAK1 inhibitors with placebo or another active agent for CD were included in the comparative analysis. Efficacy outcomes were the induction of remission, maintenance of remission and steroid-free remission, and safety outcomes were serious adverse events (AEs) and infections. The Bayesian method was utilized to compare the treatments. The registration number is CRD42020187807. Results: Twenty-eight studies and 29 RCTs were identified in our systematic review. The network meta-analysis demonstrated that infliximab and adalimumab were superior to certolizumab pegol (OR 2.44, 95% CI 1.35–4.97; OR 2.96, 95% CI 1.57–5.40, respectively) and tofacitinib (OR 2.55, 95% CI 1.27–5.97; OR 3.10, 95% CI 1.47–6.52, respectively) and revealed the superiority of CT-P13 compared with placebo (OR 2.90, 95% CI 1.31–7.59) for the induction of remission. Infliximab (OR 7.49, 95% CI 1.85–34.77), adalimumab (OR 10.76, 95% CI 2.61–52.35), certolizumab pegol (OR 4.41, 95% CI 1.10–21.08), vedolizumab (OR 4.99, 95% CI 1.19–25.54) and CT-P13 (OR 10.93, 95% CI 2.10–64.37) were superior to filgotinib for the maintenance of remission. Moreover, infliximab (OR 3.80, 95% CI 1.49–10.23), adalimumab (OR 4.86, 95% CI 1.43–16.95), vedolizumab (OR 2.48, 95% CI 1.21–6.52) and CT-P13 (OR 5.15, 95% CI 1.05–27.58) were superior to placebo for steroid-free remission. Among all treatments, adalimumab ranked highest for the induction of remission, and CT-P13 ranked highest for the maintenance of remission and steroid-free remission. Conclusion: CT-P13 was more efficacious than numerous biological agents and JAK1 inhibitors and should be recommended for the treatment of CD. Further head-to-head RCTs are warranted to compare these drugs.
Collapse
Affiliation(s)
- Guozhi Wu
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Gastroenterology, Lanzhou University, Lanzhou, China
| | - Yuan Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Gastroenterology, Lanzhou University, Lanzhou, China
| | - Min Liu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Gastroenterology, Lanzhou University, Lanzhou, China
| | - Yuping Wang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Gastroenterology, Lanzhou University, Lanzhou, China
| | - Qinghong Guo
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Gastroenterology, Lanzhou University, Lanzhou, China
| |
Collapse
|
3
|
Rankala R, Kosonen J, Mattila K, Tuominen R, Voutilainen M, Mustonen A. Direct costs of inflammatory bowel diseases in a Finnish tertiary-level clinic. Frontline Gastroenterol 2020; 12:385-389. [PMID: 35401962 PMCID: PMC8988997 DOI: 10.1136/flgastro-2020-101466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases associated with a high and continuous economic burden. The introduction of biologics has changed the distribution of costs over the past two decades, and there are no recent studies on direct costs in Finland. This study aimed to estimate the direct healthcare costs of these diseases in a tertiary-level clinic. METHODS The data were collected during a 1-year period of patients with IBD visiting Turku University Hospital. Patients were included if they lived in the hospital district area and were over 18 years old. This comprised an IBD group of 2208 patients, including 794 cases of CD and 1414 cases of UC. A sex-matched and age-matched control group was collected for comparison. Direct costs were collected during a 1-year study period from the hospital records. RESULTS Total direct costs per patient with IBD in a tertiary-level clinic were €4223 annually. IBD-generated direct costs were estimated to total €3981 per patient annually. Patients with IBD who were given infliximab had €9157 higher direct healthcare costs per patient annually than patients with IBD with no infliximab medication. Direct healthcare costs generated in a tertiary-level gastroenterological clinic averaged €1652 per patient with IBD annually. On average, patients with CD had €1111 higher direct healthcare costs annually than patients with UC. CONCLUSIONS The direct healthcare costs of IBD were significant, almost 17-fold higher compared with a control group. Patients with IBD administered with biologics had significantly higher costs. Patients with CD had higher annual infliximab costs than patients with UC.
Collapse
Affiliation(s)
| | - Juuso Kosonen
- Internal Medicine, University of Turku, Turku, Finland
| | - Kalle Mattila
- Internal Medicine, University of Turku, Turku, Finland,Public Health, Faculty of Medicine, Turku, Finland
| | | | | | | |
Collapse
|
4
|
Principi M, Labarile N, Bianchi FP, Contaldo A, Tafuri S, Ierardi E, Di Leo A. The Cost of Inflammatory Bowel Disease Management Matches with Clinical Course: A Single Outpatient Centre Analysis. Int J Environ Res Public Health 2020; 17:E4549. [PMID: 32599816 DOI: 10.3390/ijerph17124549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/26/2022]
Abstract
Inflammatory bowel diseases (IBD) have a large economic burden on health systems. Our single-centre observational retrospective study aimed to assess an economic evaluation in two IBD outpatient cohorts (biological and conventional therapy) in relation to disease activity within a three-year follow-up. Four hundred and seventeen consecutive IBD patients referred to our tertiary gastroenterology unit (Bari-Puglia-Southern Italy) on January 2014–December 2016 were included. For each group (conventional/biological), we assessed direct/indirect costs and clinical/endoscopic activity within the first year and along the three-year follow-up. Statistical analyses: Wilcoxon signed-rank test (continuous variables), chi-square and Fisher’s test (categorical variables), Spearman ranks (single outcome) and ANOVA (detection time, clinical/endoscopic scores) were used. Continuous variables were expressed as mean ± standard deviation and range and/or median, interquartile range and range; categorical variables were expressed as proportions with 95% confidence interval. Direct and indirect cost items of 2014 and 2014–2016 were higher in patients treated with biological than conventional therapy. Subjects on biological therapy were younger and showed clinical and endoscopic moderate-to-severe disease activity. After three years, they reached a significant improvement from baseline. Conversely, disease activity was mild when conventional treatment had a beneficial effect. In conclusion, overall IBD management cost matches with clinical course and needs long-term evaluation in critical patients.
Collapse
|
5
|
Burisch J, Vardi H, Schwartz D, Friger M, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Lakatos L, Lakatos PL, D'Incà R, Sartini A, Valpiani D, Giannotta M, Arebi N, Duricova D, Bortlik M, Chetcuti Zammit S, Ellul P, Pedersen N, Kjeldsen J, Midjord JMM, Nielsen KR, Winther Andersen K, Andersen V, Katsanos KH, Christodoulou DK, Domislovic V, Krznaric Z, Sebastian S, Oksanen P, Collin P, Barros L, Magro F, Salupere R, Kievit HAL, Goldis A, Kaimakliotis IP, Dahlerup JF, Eriksson C, Halfvarson J, Fernandez A, Hernandez V, Turcan S, Belousova E, Langholz E, Munkholm P, Odes S. Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study. Lancet Gastroenterol Hepatol 2020; 5:454-464. [PMID: 32061322 DOI: 10.1016/s2468-1253(20)30012-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.
Collapse
Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark.
| | - Hillel Vardi
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Liver Diseases, Soroka Medical Centre, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gediminas Kiudelis
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University, Lille, France; Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Renata D'Incà
- Department of Surgical, Oncological, and Gastroenterological Sciences, Azienda, University of Padua, Padua, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Bufalini Hospital Cesena, AUSL della Romagna, Rimini, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia Digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | - Naila Arebi
- Inflammatory Bowel Disease Department, Imperial College London, London, UK
| | - Dana Duricova
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | | | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | | | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | | | - Adrian Goldis
- Clinic of Gastroenterology, Victor Babeş University of Medicine, Timisoara, Romania
| | | | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Vicent Hernandez
- Department of Gastroenterology, Instituto de Investigación Sanitaria Galicia Sur, Hospital Alvaro Cunqueiro, Xerencia Xestion Integrada de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Selwyn Odes
- Department of Internal Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | |
Collapse
|
6
|
Abstract
Crohn's disease and ulcerative colitis are increasingly prevalent, relapsing and remitting inflammatory bowel diseases (IBDs) with variable disease courses and complications. Their aetiology remains unclear but current evidence shows an increasingly complex pathophysiology broadly centring on the genome, exposome, microbiome and immunome. Our increased understanding of disease pathogenesis is providing an ever-expanding arsenal of therapeutic options, but these can be expensive and patients can lose response or never respond to certain therapies. Therefore, there is now a growing need to personalise therapies on the basis of the underlying disease biology and a desire to shift our approach from "reactive" management driven by disease complications to "proactive" care with an aim to prevent disease sequelae. Precision medicine is the tailoring of medical treatment to the individual patient, encompassing a multitude of data-driven (and multi-omic) approaches to foster accurate clinical decision-making. In IBD, precision medicine would have significant benefits, enabling timely therapy that is both effective and appropriate for the individual. In this review, we summarise some of the key areas of progress towards precision medicine, including predicting disease susceptibility and its course, personalising therapies in IBD and monitoring response to therapy. We also highlight some of the challenges to be overcome in order to deliver this approach.
Collapse
Affiliation(s)
- Simon P. Borg-Bartolo
- Department of Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Ray Kiran Boyapati
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Rahul Kalla
- Department of Gastroenterology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| |
Collapse
|
7
|
Lo B, Vind I, Vester-Andersen MK, Bendtsen F, Burisch J. Direct and Indirect Costs of Inflammatory Bowel Disease: Ten Years of Follow-up in a Danish Population-based Inception Cohort. J Crohns Colitis 2020; 14:53-63. [PMID: 31076743 DOI: 10.1093/ecco-jcc/jjz096] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease [IBD], encompassing Crohn's disease [CD] and ulcerative colitis [UC], places a high burden on health care resources. To date, no study has assessed the combined direct and indirect cost of IBD in a population-based setting. Our aim was to assess this in a population-based inception cohort with 10 years of follow-up. METHODS All incident patients diagnosed with CD or UC, 2003-2004, in a well-defined area of Copenhagen, were followed prospectively until 2015. Direct and indirect costs were retrieved from Danish national registries. Data were compared with a control population [1:20]. Associations between the costs and multiple variables were assessed. RESULTS A total of 513 (CD: 213 [42%], UC: 300 [58%]) IBD patients were included. No significant differences were found in indirect costs between CD, UC, and the control population. Costs for CD patients were significantly higher than those for UC regarding all direct expenditures (except for5-aminosalicylates [5-ASA] and diagnostic expenses). Biologics accounted for €1.6 and €0.3 million for CD and UC, respectively. The total costs amounted to €42.6 million. Only patients with extensive colitis had significantly higher direct costs (proctitis: €2273 [1341-4092], left-sided: €3606 [2354-5311], extensive: €4093 [2313-6057], p <0.001). No variables were significantly associated with increased total costs in CD or in UC patients. CONCLUSIONS In this prospective population-based cohort, direct costs for IBD remain high. However, indirect costs did not surpass the control population. Total costs were mainly driven by hospitalisation, but indirect costs accounted for a higher percentage overall, although these did decrease over time. PODCAST This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
Collapse
Affiliation(s)
- Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Marianne Kajbaek Vester-Andersen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Medical Department, Zealand University Hospital, Koege, Denmark
| | - Flemming Bendtsen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
8
|
Prasad SS, Potter M, Keely S, Talley NJ, Walker MM, Kairuz T. Roles of healthcare professionals in the management of chronic gastrointestinal diseases with a focus on primary care: A systematic review. JGH Open 2019; 4:221-229. [PMID: 32280768 PMCID: PMC7144774 DOI: 10.1002/jgh3.12235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 02/06/2023]
Abstract
Background and aim Inflammatory bowel disease (IBD) refers to a group of complex and chronic conditions that requires long‐term care delivered by a group of healthcare professionals through a multidisciplinary care model. We conducted a systematic review to examine and understand the role of healthcare professionals in the primary care management of IBD, and identify the gaps in IBD management that could be filled by primary care providers such as general practitioners (GPs) and pharmacists. Methods The search strategy retrieved published studies from five databases, and eligible articles were assessed for quality. A gray literature search of the websites of organizations was also undertaken. Results Twenty‐one studies were included, of which 19 were peer‐reviewed research articles and two reports were from organizational bodies. Although studies have shown the roles of GPs, pharmacists, dietitians, and psychologists in IBD management, nurses and gastroenterologists were the key drivers delivering specialized care to IBD patients. Many key services are accessible only for hospital inpatients (tertiary care) or through outpatient clinics (secondary care) with an absence of a multidisciplinary approach including GPs and pharmacists. Conclusion Gastroenterologists and nurses have an important role in the delivery of care to patients with chronic gastrointestinal diseases including IBD, coeliac disease, irritable bowel syndrome, and functional dyspepsia. The role of nurses includes provision of specialized care to IBD patients, as well as supportive care such as education, monitoring of therapy, and ongoing assistance. The available evidence shows many opportunities for primary care providers to play a more active role in the management of IBD patients.
Collapse
Affiliation(s)
- Sharmila S Prasad
- Faculty of Health and Medicine, School of Biomedical Science and Pharmacy University of Newcastle Callaghan New South Wales Australia.,Priority Research Centre, Digestive Health and Neurogastroenterology University of Newcastle New Lambton Heights New South Wales Australia
| | - Michael Potter
- Priority Research Centre, Digestive Health and Neurogastroenterology University of Newcastle New Lambton Heights New South Wales Australia.,Faculty of Health and Medicine, School of Medicine and Public Health University of Newcastle New Lambton Heights New South Wales Australia
| | - Simon Keely
- Faculty of Health and Medicine, School of Biomedical Science and Pharmacy University of Newcastle Callaghan New South Wales Australia.,Priority Research Centre, Digestive Health and Neurogastroenterology University of Newcastle New Lambton Heights New South Wales Australia
| | - Nicholas J Talley
- Priority Research Centre, Digestive Health and Neurogastroenterology University of Newcastle New Lambton Heights New South Wales Australia.,Faculty of Health and Medicine, School of Medicine and Public Health University of Newcastle New Lambton Heights New South Wales Australia
| | - Marjorie M Walker
- Priority Research Centre, Digestive Health and Neurogastroenterology University of Newcastle New Lambton Heights New South Wales Australia.,Faculty of Health and Medicine, School of Medicine and Public Health University of Newcastle New Lambton Heights New South Wales Australia
| | - Therése Kairuz
- Faculty of Health and Medicine, School of Biomedical Science and Pharmacy University of Newcastle Callaghan New South Wales Australia
| |
Collapse
|
9
|
Thomsen SB, Allin KH, Burisch J, Jensen CB, Hansen S, Gluud LL, Theede K, Kiszka-Kanowitz M, Nielsen AM, Jess T. Outcome of concomitant treatment with thiopurines and allopurinol in patients with inflammatory bowel disease: A nationwide Danish cohort study. United European Gastroenterol J 2019; 8:68-76. [PMID: 32213059 DOI: 10.1177/2050640619868387] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Thiopurine and allopurinol in combination are associated with clinical remission in inflammatory bowel diseases but their influence on subsequent outcomes is unclear. We compared outcomes during exposure to both thiopurines and allopurinol versus thiopurines alone. METHODS We established a nationwide cohort of patients with inflammatory bowel diseases exposed to thiopurines ± allopurinol during 1999-2014, using registry data. Patients were followed until hospitalization, surgery, anti-TNFα, or death (as a primary composite outcome). We used Poisson regression analyses to calculate incidence rate ratios overall and stratified by calendar period (assuming the combined exposure was unintended before 2009). RESULTS A total of 10,367 patients with inflammatory bowel diseases (Crohn's disease, n = 5484; ulcerative colitis, n = 4883) received thiopurines. Of these, 217 (2.1%) also received allopurinol. During 24,714 person years of follow-up, we observed 40 outcomes among thiopurine-allopurinol-exposed patients, and 4745 outcomes among those who were thiopurine exposed; incidence rate ratio, 1.26 (95% confidence interval, 0.92-1.73). The incidence rate ratios decreased over time: 4.88 (95% confidence interval 2.53-9.45) for 1999-2003, 2.19 (95% confidence interval, 1.17-4.09) for 2004-2008 and 0.80 (95% confidence interval, 0.52-1.23) for 2009-2014. CONCLUSION Our nationwide inflammatory bowel disease cohort study shows that concomitant thiopurine-allopurinol is as safe to use as thiopurines alone, with a tendency towards a positive effect on clinical outcomes in recent calendar periods when combined use was intended.
Collapse
Affiliation(s)
- Sandra Bohn Thomsen
- The Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Kristine Højgaard Allin
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Johan Burisch
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Camilla Bjørn Jensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Susanne Hansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lise Lotte Gluud
- The Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Klaus Theede
- The Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | | | - Tine Jess
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
10
|
Ye BD, Pesegova M, Alexeeva O, Osipenko M, Lahat A, Dorofeyev A, Fishman S, Levchenko O, Cheon JH, Scribano ML, Mateescu RB, Lee KM, Eun CS, Lee SJ, Lee SY, Kim H, Schreiber S, Fowler H, Cheung R, Kim YH. Efficacy and safety of biosimilar CT-P13 compared with originator infliximab in patients with active Crohn's disease: an international, randomised, double-blind, phase 3 non-inferiority study. Lancet 2019; 393:1699-1707. [PMID: 30929895 DOI: 10.1016/s0140-6736(18)32196-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The infliximab biosimilar CT-P13 was approved for use in Crohn's disease after clinical comparison with originator infliximab in ankylosing spondylitis and rheumatoid arthritis; however, concerns about such indication extrapolation have been expressed. This study investigated whether CT-P13 is non-inferior to infliximab in patients with Crohn's disease who were naive to biological therapy. METHODS In this randomised, multicentre, double-blind, phase 3 non-inferiority study, we enrolled patients with active Crohn's disease who had not responded to, or were intolerant to, non-biological treatments. Patients were randomly assigned (1:1:1:1) to receive CT-P13 then CT-P13, CT-P13 then infliximab, infliximab then infliximab, or infliximab then CT-P13, with switching occurring at week 30. Patients received 5 mg/kg CT-P13 or infliximab at weeks 0, 2, 6, and then every 8 weeks up to week 54. The primary endpoint was the proportion of patients with a decrease of 70 points or more in Crohn's Disease Activity Index (CDAI) from baseline to week 6. A non-inferiority margin of -20% was set (CT-P13 was non-inferior to infliximab if the lower limit of the two-sided 95% CI for the treatment difference was greater than -20). This trial is registered with ClinicalTrials.gov, number NCT02096861, and is completed. FINDINGS Between Aug 20, 2014, and Feb 15, 2017, 308 patients were assessed for eligibility, and 220 patients were enrolled: 111 were randomly assigned to initiate CT-P13 (56 to the CT-P13-CT-P13 group and 55 to the CT-P13-infliximab group) and 109 to initiate infliximab (54 to the infliximab-infliximab group and 55 to the infliximab-CT-P13 group). CDAI-70 response rates at week 6 were similar for CT-P13 (77 [69·4%, 95% CI 59·9 to 77·8] of 111) and infliximab (81 [74·3%, 95% CI 65·1 to 82·2] of 109; difference -4·9% [95% CI -16·9 to 7·3]), thereby establishing non-inferiority. Over the total study period, 147 (67%) patients experienced at least one treatment-emergent adverse event (36 [64%] in the CT-P13-CT-P13 group, 34 [62%] in the CT-P13-infliximab group, 37 [69%] in the infliximab-infliximab group, and 40 [73%] in the infliximab-CT-P13 group). INTERPRETATION This study showed non-inferiority of CT-P13 to infliximab in patients with active Crohn's disease. Biosimilar CT-P13 could be a new option for the treatment of active Crohn's disease. FUNDING Celltrion, Pfizer.
Collapse
Affiliation(s)
- Byong Duk Ye
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | | | - Olga Alexeeva
- Nizhny Novgorod Regional Clinical Hospital N A Semashko, Nizhny Novgorod, Russia
| | | | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Gan, Israel
| | - Andriy Dorofeyev
- Medical Center LLC Ukrainian German Antiulcer Gastroenterology Center BIK Kyiv, Kyiv, Ukraine
| | - Sigal Fishman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Gan, Israel
| | - Olena Levchenko
- Munipial Institution Odesa Regional Clinical Hospital, Odesa, Ukraine
| | - Jae Hee Cheon
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Maria Lia Scribano
- Gastroenterology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Radu-Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Kang-Moon Lee
- St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Chang Soo Eun
- Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | | | | | | | - Stefan Schreiber
- University-Hospital Schleswig-Holstein, Christian-Albrechts-University, Dep Medicine I, Kiel, Germany
| | | | | | - Young-Ho Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
11
|
Correal EN, Leiva OB, Galguera AD, Barrero MG, Pastor ES, Gonzalo MFM. Nurse-Led Telephone Advice Line for Patients With Inflammatory Bowel Disease: A Cross-Sectional Multicenter Activity Analysis. Gastroenterol Nurs 2019; 42:133-9. [PMID: 30946300 DOI: 10.1097/SGA.0000000000000372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Telephone helplines is an effective method for helping patients with chronic diseases, including inflammatory bowel disease (IBD). The objective of this cross-sectional multicenter study was to assess reasons for consultation by patients with IBD to a nurse-led telephone service. The sample included 7,273 IBD patients from 6 public hospitals in Barcelona, Spain. Data collected included calls registered during 50 working days including caller characteristics, reason for consultation, patient's diagnosis, and action recommended. The most common reasons for consultation were suspicion of relapse, doubts regarding medication, drug monitoring, side effects, visit appointment, and request of test results. In 63.7% of cases, telephone calls were solved solely by nurses, and in 35.9% in collaboration with a physician. Patient's questions were resolved via telephone in 89.3%. Findings from this study add support of the nurse's role for providing an effective telephone service for resolution of a wide range of patient queries in IBD. Helplines managed by IBD nurses may be a key element for patient-centered care.
Collapse
|
12
|
Kelso M, Weideman RA, Cipher DJ, Feagins LA. Factors Associated With Length of Stay in Veterans With Inflammatory Bowel Disease Hospitalized for an Acute Flare. Inflamm Bowel Dis 2017; 24:5-11. [PMID: 29272483 DOI: 10.1093/ibd/izx020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reducing hospital costs and risk of complications by shortening length of stay has become paramount. The aim of our study was to identify predictors and potentially modifiable factors that influence length of stay among veterans with inflammatory bowel disease admitted for an acute flare. METHODS Retrospective review of patients admitted to the Dallas VA with an acute flare of their inflammatory bowel disease between 2000 and 2015. Patients with a length of stay of ≤4 days were compared with those whose length of stay >4 days. RESULTS A total of 180 admissions involving 113 patients (59 with ulcerative colitis and 54 with Crohn's disease) were identified meeting inclusion criteria. The mean length of stay was 5.3 ± 6.8 days, and the median length of stay was 3.0 days. On multiple logistic regression analysis, initiation of a biologic, having undergone 2 or more imaging modalities, and treatment with intravenous steroids were significant predictors of longer lengths of stay, even after controlling for age and comorbid diseases. CONCLUSIONS We identified several predictors for longer hospital length of stay, most related to disease severity but several of which may be modifiable to reduce hospital stays, including most importantly consideration of earlier prebiologic testing. Future studies are needed to evaluate the impact of interventions targeting modifiable predictors of length of stay on health care utilization and patient outcomes.
Collapse
Affiliation(s)
- Michael Kelso
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas.,Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Daisha J Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Linda A Feagins
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas.,Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
13
|
Sarid O, Slonim-Nevo V, Sergienko R, Pereg A, Chernin E, Singer T, Greenberg D, Schwartz D, Vardi H, Friger M, Odes S. Daily hassles score associates with the somatic and psychological health of patients with Crohn's disease. J Clin Psychol 2017; 74:969-988. [PMID: 29244192 DOI: 10.1002/jclp.22561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/20/2017] [Accepted: 09/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the associations of daily hassles with the somatic and psychological health of Crohn's disease (CD) patients. METHOD A cross-sectional study of 400 self-selected adult CD patients was performed with completion of demographic, medical, and psychosocial questionnaires: economic status; Patient Harvey-Bradshaw Index of disease activity; Daily Hassles Scale (DHS); Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and Short-Form Health Survey (SF-36 Physical and Mental Health) quality of life measures; Brief Symptom Inventory of psychological stress with summary Global Severity Index (GSI); Family Assessment Device; and List of Threatening Life Experiences. Analyses included correlations, regressions, and Sobel test statistic. RESULTS The patients were aged 38.7 ± 14.1 years, 61% female and 67% working. The Patient Harvey-Bradshaw Index was 5.52 ± 4.87. The DHS was 88.0 ± 23.2, similar in men and women, higher in smokers, and increased with greater disease activity (p < .001). The most commonly reported hassles were time, social, and work. DHS had significant negative correlations with age, disease duration, and economic status and positive correlations with GSI, SF-36, and SIBDQ. An increased Daily Hassles score was associated with reduced SIBDQ (p < .001) and SF-36 Mental Health (p < .001) and increased GSI (p < .001) and Patient Harvey-Bradshaw Index (p < .001). This effect of DHS on Patient Harvey-Bradshaw Index was mediated by GSI (Sobel t = 6.09, p < 0.001). CONCLUSION Daily hassles in CD patients are shown for the first time to be associated with increased psychological stress and disease activity and reduced quality of life and lower economic status. This has psychotherapeutic implications.
Collapse
|
14
|
Bähler C, Vavricka SR, Schoepfer AM, Brüngger B, Reich O. Trends in prevalence, mortality, health care utilization and health care costs of Swiss IBD patients: a claims data based study of the years 2010, 2012 and 2014. BMC Gastroenterol 2017; 17:138. [PMID: 29197335 PMCID: PMC5712179 DOI: 10.1186/s12876-017-0681-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/16/2017] [Indexed: 12/13/2022] Open
Abstract
Background Real-life data on inflammatory bowel disease (IBD) prevalence and costs are scarce. The aims of this study were to provide an overview of the prevalence, mortality, health care utilization and costs of IBD patients in Switzerland in the years 2010, 2012, and 2014. Methods Based on claims data of the Helsana-Group, prevalence of IBD was assessed for 2010, 2012 and 2014. Mortality rates, costs (inpatient, outpatient, medication costs) and utilization (visits, hospitalizations) were compared between patients with and without IBD, and between IBD patients treated with and without biologics. Results were extrapolated to the Swiss general population using national census data. Multivariate linear regression was used to identify socio-demographic and regional factors influencing total costs. Results The overall extrapolated prevalence rates of IBD were 0.32% in 2010, 0.38% in 2012, and 0.41% in 2014. Mortality rate didn’t differ between the IBD and non-IBD population. Costs increased annually by 6% in IBD versus 2.4% in non-IBD subjects, which was solely due to increased outpatient costs. Almost one-fourth of IBD patients were hospitalized at least once a year. Costs were higher in IBD patients treated with biologics (OR = 3.98, CI: 3.72-4.27, p < 0.001) when compared to IBD patients without biologic therapies. Over 70% of the total costs in IBD patients treated with biologics were due to drug costs, compared with 28% in patients without use of biologic therapies, whereas inpatient costs didn’t differ. Conclusions The prevalence of IBD seems to be increasing in Switzerland. Outpatient costs increased substantially, while no decrease in inpatient costs was found. Treatment of IBD is more and more based on biologic therapies. Electronic supplementary material The online version of this article (10.1186/s12876-017-0681-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Group, P.O. Box 8081, Zürich, Switzerland.
| | - Stephan R Vavricka
- Department Gastroenterology and Hepatology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois/CHUV, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, P.O. Box 8081, Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, P.O. Box 8081, Zürich, Switzerland
| |
Collapse
|
15
|
A SPECIAL MEETING REVIEW EDITION: Highlights in Biosimilars From the World Congress of Gastroenterology at ACG 2017: Introduction: A Review of Selected Presentations From the World Congress of Gastroenterology at ACG 2017 • October 13-18, 2017 • Orlando, FloridaSpecial Reporting on:• Biosimilars: What Are They and How Will They Change the Way We Practice?• Infliximab Assay Used in Clinical Practice Validated for Measuring SB2 Infliximab Biosimilar's Serum Drug and Anti-Drug Antibody Levels• Efficacy of Infliximab Biosimilar for Induction and Maintenance Therapy in Inflammatory Bowel Disease After Switch From Drug Originator: A Meta-Analysis• Long-Term Efficacy, Safety, and Immunogenicity Data From a Phase III Confirmatory Study Comparing GP2017, a Proposed Biosimilar, With Reference Adalimumab• Patient Perceptions Regarding the Use of Biosimilars in Inflammatory Bowel Disease• FDA Public Forum on BiosimilarsWith an Introduction and Expert Commentary by:Gary R. Lichtenstein, MDProfessor of MedicineDirector, Center for Inflammatory Bowel DiseaseUniversity of Pennsylvania Health SystemHospital of the University of PennsylvaniaPhiladelphia, Pennsylvania. Gastroenterol Hepatol (N Y) 2017; 13:1-20. [PMID: 30042651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
16
|
Bähler C, Schoepfer AM, Vavricka SR, Brüngger B, Reich O. Chronic comorbidities associated with inflammatory bowel disease: prevalence and impact on healthcare costs in Switzerland. Eur J Gastroenterol Hepatol 2017; 29:916-25. [PMID: 28471826 DOI: 10.1097/MEG.0000000000000891] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) was shown to be associated with a variety of chronic comorbidities. We aimed to evaluate the frequency of 21 chronic conditions and compared frequencies in IBD and non-IBD populations. Further, healthcare costs of those (additional) chronic conditions were calculated. PATIENTS AND METHODS A total of 4791 IBD patients, who were insured at Helsana Insurance Group in 2014, were compared with 1 114 638 individuals without IBD. Entropy balancing was performed to create balanced samples. Chronic conditions were identified by means of the updated Pharmacy-based Cost Group model. Multivariate log-transformed linear regression modeling was performed to estimate the effect of the morbidity status (non-IBD +none, +1, +2, and +3 or more chronic conditions) on the healthcare costs. RESULTS Overall, 78% of IBD patients had at least one comorbidity, with a median of three comorbidities. Largest differences between individuals with and without IBD were found for rheumatologic conditions, acid-related disorders, pain, bone diseases, migraines, cancer, and iron-deficiency anemia, whereas no significant differences between the two groups were found for diabetes, dementia, hyperlipidemia, glaucoma, gout, HIV, psychoses, and Parkinson's disease after adjustments for a variety of covariates. Each increase in the morbidity status led to increased healthcare costs; rheumatologic conditions, acid-related disorders, and pain as the most frequent comorbidities more than doubled total costs in IBD patients. CONCLUSION We found a considerably high prevalence of concomitant chronic diseases in IBD patients. This was associated with considerably higher healthcare costs, especially in the outpatient setting.
Collapse
|
17
|
de Ramón-Fernández A, Ruiz-Fernández D, Marcos-Jorquera D, Gilart-Iglesias V, Vives-Boix V. Monitoring-Based Model for Personalizing the Clinical Process of Crohn's Disease. Sensors (Basel) 2017; 17:s17071570. [PMID: 28678162 PMCID: PMC5539866 DOI: 10.3390/s17071570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/24/2017] [Accepted: 06/30/2017] [Indexed: 12/22/2022]
Abstract
Crohn’s disease is a chronic pathology belonging to the group of inflammatory bowel diseases. Patients suffering from Crohn’s disease must be supervised by a medical specialist for the rest of their lives; furthermore, each patient has its own characteristics and is affected by the disease in a different way, so health recommendations and treatments cannot be generalized and should be individualized for a specific patient. To achieve this personalization in a cost-effective way using technology, we propose a model based on different information flows: control, personalization, and monitoring. As a result of the model and to perform a functional validation, an architecture based on services and a prototype of the system has been defined. In this prototype, a set of different devices and technologies to monitor variables from patients and their environment has been integrated. Artificial intelligence algorithms are also included to reduce the workload related to the review and analysis of the information gathered. Due to the continuous and automated monitoring of the Crohn’s patient, this proposal can help in the personalization of the Crohn’s disease clinical process.
Collapse
Affiliation(s)
| | | | | | | | - Víctor Vives-Boix
- Department of Computer Technology, University of Alicante, Alicante 03690, Spain.
| |
Collapse
|
18
|
Sarid O, Slonim-Nevo V, Pereg A, Friger M, Sergienko R, Schwartz D, Greenberg D, Shahar I, Chernin E, Vardi H, Eidelman L, Segal A, Ben-Yakov G, Gaspar N, Munteanu D, Rozental A, Mushkalo A, Dizengof V, Abu-Freha N, Fich A, Odes S; Israeli IBD Research Nucleus (IIRN). Coping strategies, satisfaction with life, and quality of life in Crohn's disease: A gender perspective using structural equation modeling analysis. PLoS One 2017; 12:e0172779. [PMID: 28245260 DOI: 10.1371/journal.pone.0172779] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 02/09/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To identify coping strategies and socio-demographics impacting satisfaction with life and quality of life in Crohn's disease (CD). METHODS 402 patients completed the Patient Harvey-Bradshaw Index, Brief COPE Inventory, Satisfaction with Life Scale (SWLS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We performed structural equation modeling (SEM) of mediators of quality of life and satisfaction with life. RESULTS The cohort comprised: men 39.3%, women 60.1%; P-HBI 4.75 and 5.74 (p = 0.01). In inactive CD (P-HBI≤4), both genders had SWLS score 23.8; men had SIBDQ score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men. In active CD, SWLS and SIBDQ scores were reduced, without gender differences; men and women used coping strategies equally. A SEM model (all patients) had a very good fit (X2(6) = 6.68, p = 0.351, X2/df = 1.114, SRMR = 0.045, RMSEA = 0.023, CFI = 0.965). In direct paths, economic status impacted SWLS (β = 0.39) and SIBDQ (β = 0.12), number of children impacted SWLS (β = 0.10), emotion-focused coping impacted SWLS (β = 0.11), dysfunctional coping impacted SWLS (β = -0.25). In an indirect path, economic status impacted dysfunctional coping (β = -0.26), dysfunctional coping impacted SIBDQ (β = -0.36). A model split by gender and disease activity showed that in active CD economic status impacted SIBDQ in men (β = 0.43) more than women (β = 0.26); emotional coping impacted SWLS in women (β = 0.36) more than men (β = 0.14). CONCLUSIONS Gender differences in coping and the impacts of economic status and emotion-focused coping vary with activity of CD. Psychological treatment in the clinic setting might improve satisfaction with life and quality of life in CD patients.
Collapse
|
19
|
Mao EJ, Hazlewood GS, Kaplan GG, Peyrin-Biroulet L, Ananthakrishnan AN. Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther 2017; 45:3-13. [PMID: 27862107 DOI: 10.1111/apt.13847] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/26/2016] [Accepted: 10/09/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Crohn's disease (CD) and ulcerative colitis (UC) have a progressive course leading to hospitalisation and surgery. The ability of existing therapies to alter disease course is not clearly defined. AIM To investigate the comparative efficacy of currently available inflammatory bowel disease (IBD) therapies to reduce hospitalisation and surgery. METHODS We conducted a systematic review in MEDLINE/PubMed for randomised controlled trials (RCT) published between January 1980 and May 2016 examining efficacy of biological or immunomodulator therapy in IBD. We performed direct comparisons of pooled proportions of hospitalisation and surgery. Pair-wise comparisons using a random-effects Bayesian network meta-analysis were performed to assess comparative efficacy of different treatments. RESULTS We identified seven randomised controlled trials (5 CD; 2 UC) comparing three biologics and one immunomodulator with placebo. In CD, anti-TNF biologics significantly reduced hospitalisation [Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.36-0.60] and surgery (OR 0.23, 95% CI 0.13-0.42) compared to placebo. No statistically significant reduction was noted with azathioprine or vedolizumab. Azathioprine was inferior to both infliximab and adalimumab in preventing CD-related hospitalisation (>97.5% probability). Anti-TNF biologics significantly reduced hospitalisation (OR 0.48, 95% CI 0.29-0.80) and surgery (OR 0.67, 95% CI 0.46-0.97) in UC. There were no statistically significant differences in the pair-wise comparisons between active treatments. CONCLUSIONS In CD and UC, anti-TNF biologics are efficacious in reducing the odds of hospitalisation by half and surgery by 33-77%. Azathioprine and vedolizumab were not associated with a similar improvement, but robust conclusions may be limited due to paucity of RCTs.
Collapse
Affiliation(s)
- E J Mao
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, RI, USA
| | - G S Hazlewood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - G G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - L Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre, France
| | - A N Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
20
|
Huppertz-Hauss G, Aas E, Lie Høivik M, Langholz E, Odes S, Småstuen M, Stockbrugger R, Hoff G, Moum B, Bernklev T. Comparison of the Multiattribute Utility Instruments EQ-5D and SF-6D in a Europe-Wide Population-Based Cohort of Patients with Inflammatory Bowel Disease 10 Years after Diagnosis. Gastroenterol Res Pract 2016; 2016:5023973. [PMID: 27630711 DOI: 10.1155/2016/5023973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023] Open
Abstract
Background. The treatment of chronic inflammatory bowel disease (IBD) is costly, and limited resources call for analyses of the cost effectiveness of therapeutic interventions. The present study evaluated the equivalency of the Short Form 6D (SF-6D) and the Euro QoL (EQ-5D), two preference-based HRQoL instruments that are broadly used in cost-effectiveness analyses, in an unselected IBD patient population. Methods. IBD patients from seven European countries were invited to a follow-up visit ten years after their initial diagnosis. Clinical and demographic data were assessed, and the Short Form 36 (SF-36) was employed. Utility scores were obtained by calculating the SF-6D index values from the SF-36 data for comparison with the scores obtained with the EQ-5D questionnaire. Results. The SF-6D and EQ-5D provided good sensitivities for detecting disease activity-dependent utility differences. However, the single-measure intraclass correlation coefficient was 0.58, and the Bland-Altman plot indicated numerous values beyond the limits of agreement. Conclusions. There was poor agreement between the measures retrieved from the EQ-5D and the SF-6D utility instruments. Although both instruments may provide good sensitivity for the detection of disease activity-dependent utility differences, the instruments cannot be used interchangeably. Cost-utility analyses performed with only one utility instrument must be interpreted with caution.
Collapse
|
21
|
Forrest CB, Margolis P, Seid M, Colletti RB. PEDSnet: how a prototype pediatric learning health system is being expanded into a national network. Health Aff (Millwood) 2016; 33:1171-7. [PMID: 25006143 DOI: 10.1377/hlthaff.2014.0127] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Except for a few conditions, pediatric disorders are rare diseases. Because of this, no single institution has enough patients to generate adequate sample sizes to produce generalizable knowledge. Aggregating electronic clinical data from millions of children across many pediatric institutions holds the promise of producing sufficiently large data sets to accelerate knowledge discovery. However, without deliberately embedding these data in a pediatric learning health system (defined as a health care organization that is purposefully designed to produce research in routine care settings and implement evidence at the point of care), efforts to act on this new knowledge, reducing the distress and suffering that children experience when sick, will be ineffective. In this article we discuss a prototype pediatric learning health system, ImproveCareNow, for children with inflammatory bowel disease. This prototype is being scaled up to create PEDSnet, a national network that will support the efficient conduct of clinical trials, observational research, and quality improvement across diseases, specialties, and institutions.
Collapse
Affiliation(s)
- Christopher B Forrest
- Christopher B. Forrest is a professor of pediatrics at the Children's Hospital of Philadelphia and the University of Pennsylvania as well as principal investigator for the PEDSnet learning health system, all in Philadelphia
| | - Peter Margolis
- Peter Margolis is a professor of pediatrics and director of research at the James M. Anderson Center for Health Systems Excellence at the Cincinnati Children's Hospital Medical Center, in Ohio, and scientific director of the ImproveCareNow network
| | - Michael Seid
- Michael Seid is director of health outcomes and quality of care research in the Division of Pulmonary Medicine and a professor of pediatrics at the Cincinnati Children's Hospital Medical Center
| | - Richard B Colletti
- Richard B. Colletti is a professor of pediatrics at the University of Vermont College of Medicine, in Burlington, and network director of the ImproveCareNow network
| |
Collapse
|
22
|
Abstract
BACKGROUND Immunomodulator and biological use in African Americans (AA) with Crohn's disease (CD) has been reported to be lower than in whites (W); less data exist for Hispanics (H). METHODS Medicaid databases from 3 states were examined for patients with CD from August 1998 to July 2009. CD-related treatments, comorbidities, location, surgery, and health care utilization were assessed from diagnosis until the first biological claim or end of claims. A Cox proportional hazard regression model was used to assess the effect of race on biological initiation. RESULTS A total of 5575 patients with CD (3590 W; 924 AA; 494 H; and 567 "other") were analyzed; 18%, 17%, and 17% of W, AA, and H patients, respectively, started immunomodulators (P = not significant); and 7%, 9%, and 5% of W, AA, and H, respectively, initiated biologics after CD diagnosis (P = not significant). After adjusting for demographics and CD-related medications and comorbidities in Cox models, no association was found between AA and W for biological use (hazard ratio 1.19; 95% confidence interval [CI], 0.91-1.54) or H and W (hazard ratio 0.68, 95% CI, 0.45-1.02). Analyzing patients hospitalized after CD diagnosis (n = 3428) to adjust for disease severity demonstrated that H were significantly less likely to use biologics than W (hazard ratio 0.40, 95% CI, 0.22-0.74). No differences between W and AA were found. CONCLUSIONS Our findings suggest that differences between AA and W in exposure to immunomodulators or biologics may not exist, although they may be present in H with more severe disease. Further research is needed to confirm these findings.
Collapse
|
23
|
Abstract
INTRODUCTION Crohn's disease and ulcerative colitis are lifelong illnesses which have a significant impact on quality of life and personal burden through a reduction in the ability to work, sick leave and restrictions of leisure time. The aim of this study was to conduct a systematic review of the indirect costs of Crohn's disease and ulcerative colitis. MATERIAL AND METHODS The search was carried out in Medline, EMBASE, the Centre for Reviews and Dissemination, and reference lists of identified articles and reference lists of identified articles were also handsearched. All costs were adjusted to 2013 USD values by using the consumer price index and purchasing power parity. Identified studies were then analysed in order to assess their heterogeneity and possibility of inclusion in the meta-analysis. RESULTS Eleven of the identified publications presented indirect costs of Crohn's disease or ulcerative colitis. The range of estimated yearly indirect costs per patient was large, from $1 159.09 for loss of earnings to $14 135.64 for lost productivity and sick leave for Crohn's disease. The values for ulcerative colitis ranged from $926.49 to $6 583.17. Because of the imprecise definition of methods of indirect cost calculations as well as heterogeneity of indirect cost components, a meta-analysis was not performed. CONCLUSIONS The indirect costs of ulcerative colitis seem to be slightly lower than in the case of Crohn's disease. A small number of studies referring to indirect costs of Crohn's disease and ulcerative colitis were identified, which indicates the need to conduct further investigations on this problem.
Collapse
Affiliation(s)
- Paweł Kawalec
- Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
24
|
Khanna R, Bressler B, Levesque BG, Zou G, Stitt LW, Greenberg GR, Panaccione R, Bitton A, Paré P, Vermeire S, D'Haens G, MacIntosh D, Sandborn WJ, Donner A, Vandervoort MK, Morris JC, Feagan BG. Early combined immunosuppression for the management of Crohn's disease (REACT): a cluster randomised controlled trial. Lancet 2015; 386:1825-34. [PMID: 26342731 DOI: 10.1016/s0140-6736(15)00068-9] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conventional management of Crohn's disease features incremental use of therapies. However, early combined immunosuppression (ECI), with a TNF antagonist and antimetabolite might be a more effective strategy. We compared the efficacy of ECI with that of conventional management for treatment of Crohn's disease. METHODS In this open-label cluster randomised controlled trial (Randomised Evaluation of an Algorithm for Crohn's Treatment, REACT), we included community gastroenterology practices from Belgium and Canada that were willing to be assigned to either of the study groups, participate in all aspects of the study, and provide data on up to 60 patients with Crohn's disease. These practices were randomly assigned (1:1) to either ECI or conventional management. The computer-generated randomisation was minimised by country and practice size. Up to 60 consecutive adult patients were assessed within practices. Patients who were aged 18 years or older; documented to have Crohn's disease; able to speak or understand English, French, or Dutch; able to access a telephone; and able to provide written informed consent were followed up for 2 years. The primary outcome was the proportion of patients in corticosteroid-free remission (Harvey-Bradshaw Index score ≤ 4) at 12 months at the practice level. This trial is registered with ClinicalTrials.gov, number NCT01030809. FINDINGS This study took place between March 15, 2010, and Oct 1, 2013. Of the 60 practices screened, 41 were randomly assigned to either ECI (n=22) or conventional management (n=19). Two practices (one in each group) discontinued because of insufficient resources. 921 (85%) of the 1084 patients at ECI practices and 806 (90%) of 898 patients at conventional management practices completed 12 months follow-up and were included in an intention-to-treat analysis. The 12 month practice-level remission rates were similar at ECI and conventional management practices (66·0% [SD 14·0] and 61·9% [16·9]; adjusted difference 2·5%, 95% CI -5·2% to 10·2%, p=0·5169). The 24 month patient-level composite rate of major adverse outcomes defined as occurrence of surgery, hospital admission, or serious disease-related complications was lower at ECI practices than at conventional management practices (27·7% and 35·1%, absolute difference [AD] 7·3%, hazard ratio [HR]: 0·73, 95% CI 0·62 to 0·86, p=0·0003). There were no differences in serious drug-related adverse events. INTERPRETATION Although ECI was not more effective than conventional management for controlling Crohn's disease symptoms, the risk of major adverse outcomes was lower. The latter finding should be considered hypothesis-generating for future trials. ECI was not associated with an increased risk of serious drug-related adverse events or mortality. FUNDING AbbVie Pharmaceuticals.
Collapse
Affiliation(s)
- Reena Khanna
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada; Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Brian Bressler
- Department of Gastroenterology, St Paul's Hospital, Vancouver, BC, Canada
| | - Barrett G Levesque
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada; Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Guangyong Zou
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - Larry W Stitt
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada
| | | | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Pierre Paré
- Laval University, CHAUQ, Hôpital du St-Sacrement, Quebec City, QC, Canada
| | - Séverine Vermeire
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders, Leuven, Belgium
| | - Geert D'Haens
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada; Department of Gastroenterology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Donald MacIntosh
- Division of Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - William J Sandborn
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada; Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Allan Donner
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | | | - Joan C Morris
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada
| | - Brian G Feagan
- Robarts Clinical Trials Inc, Robarts Research Institute, London, ON, Canada; Department of Medicine, University of Western Ontario, London, ON, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
| |
Collapse
|
25
|
Kawalec P, Malinowski KP. Indirect health costs in ulcerative colitis and Crohn's disease: a systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:253-66. [PMID: 25656310 DOI: 10.1586/14737167.2015.1011130] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this systematic review was to collect all current data on indirect costs related to inflammatory bowel disease as well as assessing homogeneity and comparability, and conducting a meta-analysis. Costs were collected using databases from Medline, Embase and Centre for Reviews and Dissemination databases, then average annual cost per patient was calculated and expressed in 2013-rate USD using the consumer price index and purchasing power parity (scenario 1) and then adjusted to specific gross domestic product (scenario 2) to make them comparable. The studies were then included in quantitative synthesis using the meta-analysis and bootstrap methods. This systematic review was carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. From 18 publications, overall annual indirect costs per patient as a result of the quantitative synthesis among all studies eligible for meta-analysis ranged from US$2425.01-US$9622.15 depending on the scenario and model used for analysis. The cost of presenteeism was assessed in only two studies. Considering heterogeneity among all identified studies random-effect model presented the most accurate results of meta-analysis equal to US$7189.27 and US$9622.15 per patient per year for scenario 1 and scenario 2, respectively. This systematic review revealed the existence of a relatively small number of studies that reported on the great economic burden of the disease upon society. A great variety of methodologies and cost components resulted in a very large discrepancy in indirect costs and made meta-analysis difficult to perform, so two scenarios were considered and meta-analysis conducted in subgroups to make data more comparable.
Collapse
Affiliation(s)
- Paweł Kawalec
- Faculty of Health Science, Jagiellonian University Medical College, Institute of Public Health, Grzegórzecka 20, 31-531 Kraków, Poland
| | | |
Collapse
|
26
|
Burisch J, Vardi H, Pedersen N, Brinar M, Cukovic-Cavka S, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Bailey Y, OʼMorain C, Schwartz D, Lupinacci G, De Padova A, Jonaitis L, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Fernandez A, Pineda JR, Almer S, Halfvarson J, Tsai HH, Sebastian S, Friger M, Greenberg D, Lakatos PL, Langholz E, Odes S, Munkholm P; EpiCom Group. Costs and resource utilization for diagnosis and treatment during the initial year in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom Study. Inflamm Bowel Dis 2015; 21:121-31. [PMID: 25437816 DOI: 10.1097/MIB.0000000000000250] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND No direct comparison of health care cost in patients with inflammatory bowel disease across the European continent exists. The aim of this study was to assess the costs of investigations and treatment for diagnostics and during the first year after diagnosis in Europe. METHODS The EpiCom cohort is a prospective population-based inception cohort of unselected inflammatory bowel disease patients from 31 Western and Eastern European centers. Patients were followed every third month from diagnosis, and clinical data regarding treatment and investigations were collected. Costs were calculated in euros (€) using the Danish Health Costs Register. RESULTS One thousand three hundred sixty-seven patients were followed, 710 with ulcerative colitis, 509 with Crohn's disease, and 148 with inflammatory bowel disease unclassified. Total expenditure for the cohort was €5,408,174 (investigations: €2,042,990 [38%], surgery: €1,427,648 [26%], biologicals: €781,089 [14%], and standard treatment: €1,156,520 [22%)]). Mean crude expenditure per patient in Western Europe (Eastern Europe) with Crohn's disease: investigations €1803 (€2160) (P = 0.44), surgery €11,489 (€13,973) (P = 0.14), standard treatment €1027 (€824) (P = 0.51), and biologicals €7376 (€8307) (P = 0.31). Mean crude expenditure per patient in Western Europe (Eastern Europe) with ulcerative colitis: investigations €1189 ( €1518) (P < 0.01), surgery €18,414 ( €12,395) (P = 0.18), standard treatment €896 ( €798) (P < 0.05), and biologicals €5681 ( €72) (P = 0.51). CONCLUSIONS In this population-based unselected cohort, costs during the first year of disease were mainly incurred by investigative procedures and surgeries. However, biologicals accounted for >15% of costs. Long-term follow-up of the cohort is needed to assess the cost-effectiveness of biological agents.
Collapse
|
27
|
Odes S, Greenberg D. A medicoeconomic review of early intervention with biologic agents in the treatment of inflammatory bowel diseases. Clinicoecon Outcomes Res 2014; 6:431-43. [PMID: 25336980 PMCID: PMC4199854 DOI: 10.2147/ceor.s39212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The treatment of inflammatory bowel disease with standard therapy fails to control the disease in many patients. Biologic therapy has an increasing role in altering the natural history of Crohn’s disease and ulcerative colitis, and is improving patient prognosis. However, indications for treatment and issues with drug costs and value for money remain unclear. Also, when to perform early intervention with biologic agents is at present unclear. We performed an extensive literature search and review to address these issues. The biologics provide better care for many patients. The choice of biologic agent, the indications for its use, the switch between agents, and the considerations of cost are outlined, with a view to guiding the treating physician in managing these cases. Outstanding issues and anticipated future developments are defined.
Collapse
Affiliation(s)
- Shmuel Odes
- Department of Gastroenterology and Hepatology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Greenberg
- Department of Health Systems Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
28
|
Schoepfer AM, Bortolotti M, Pittet V, Mottet C, Gonvers JJ, Reich O, Fournier N, Vader JP, Burnand B, Michetti P, Froehlich F. The gap between scientific evidence and clinical practice: 5-aminosalicylates are frequently used for the treatment of Crohn's disease. Aliment Pharmacol Ther 2014; 40:930-7. [PMID: 25146487 DOI: 10.1111/apt.12929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 05/28/2014] [Accepted: 07/31/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is uncertain evidence of effectiveness of 5-aminosalicylates (5-ASA) to induce and maintain response and remission of active Crohn's disease (CD), and weak evidence to support their use in post-operative CD. AIM To assess the frequency and determinants of 5-ASA use in CD patients and to evaluate the physicians' perception of clinical response and side effects to 5-ASA. METHODS Data from the Swiss Inflammatory Bowel Disease Cohort, which collects data since 2006 on a large sample of IBD patients, were analysed. Information from questionnaires regarding utilisation of treatments and perception of response to 5-ASA were evaluated. Logistic regression modelling was performed to identify factors associated with 5-ASA use. RESULTS Of 1420 CD patients, 835 (59%) were ever treated with 5-ASA from diagnosis to latest follow-up. Disease duration >10 years and colonic location were both significantly associated with 5-ASA use. 5-ASA treatment was judged to be successful in 46% (378/825) of treatment episodes (physician global assessment). Side effects prompting stop of therapy were found in 12% (98/825) episodes in which 5-ASA had been stopped. CONCLUSIONS 5-Aminosalicylates were frequently prescribed in patients with Crohn's disease in the Swiss IBD cohort. This observation stands in contrast to the scientific evidence demonstrating a very limited role of 5-ASA compounds in the treatment of Crohn's disease.
Collapse
Affiliation(s)
- A M Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Fritze D, Zhang W, Li JY, Chai B, Mulholland M. Thrombin mediates vagal apoptosis and dysfunction in inflammatory bowel disease. J Gastrointest Surg 2014; 18:1495-506. [PMID: 24916589 DOI: 10.1007/s11605-014-2565-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/29/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND In inflammatory bowel disease, autonomic dysfunction contributes to symptoms, morbidity, and health care resource utilization. Efferent vagal neurons, which provide the primary parasympathetic input to the gastrointestinal tract, are housed in the dorsal motor nucleus of the vagus (DMV) in the brainstem. This study seeks to characterize the effects of IBD on DMV neuronal survival and function. METHODS TNBS (picrylsulfonic acid) was administered by enema to induce colitis in rats. Brain sections through the DMV were examined for neuronal apoptosis using TUNEL labeling, and for glial cell activation by immunofluorescence. Prothrombin production was evaluated via quantitative RT-PCR from DMV tissue, as well as by double immunofluorescence in DMV sections. To investigate the effects of thrombin in the DMV, thrombin or thrombin and an antagonist to its receptor were administered into the fourth ventricle via a stereotactically placed cannula. DMV sections were then examined for apoptosis by TUNEL assay. To evaluate the effect of thrombin on DMV neuronal function, we examined calcium signaling in primary DMV neuron cultures following exposure to thrombin and other neurotransmitters. RESULTS TNBS colitis is associated with significantly increased rates of DMV neuronal apoptosis, affecting 12.7 % of DMV neurons in animals with colitis, compared to 3.4 % in controls. There was a corresponding increase in DMV neuron activated caspase-3 immunoreactivity (14.8 vs. 2.6 % of DMV neurons). TNBS-treated animals also demonstrated significantly increased DMV astrocyte and microglial immunoreactivity, indicating glial cell activation. DMV prothrombin production was significantly increased in TNBS colitis, with a close anatomic relationship between prothrombin and microglia. Direct DMV exposure to thrombin replicated the apoptosis and activation of caspase-3 seen in TNBS colitis; these effects were prevented by coadministration of the PAR-1 inhibitor FR171113. Cultured DMV neurons exhibited impaired calcium signaling in response to neurotransmitters following exposure to thrombin. Glutamate-induced calcium transients decreased by 59 %, and those triggered by GABA were reduced by 61 %. PAR-1 antagonism prevented these thrombin-induced changes in calcium signaling. CONCLUSIONS IBD is associated with DMV microglial activation and production of prothrombin. Thrombin in the DMV causes vagal neuron apoptosis and decreased sensitivity to neurotransmitters.
Collapse
|
30
|
Forrest CB, Crandall WV, Bailey LC, Zhang P, Joffe MM, Colletti RB, Adler J, Baron HI, Berman J, del Rosario F, Grossman AB, Hoffenberg EJ, Israel EJ, Kim SC, Lightdale JR, Margolis PA, Marsolo K, Mehta DI, Milov DE, Patel AS, Tung J, Kappelman MD. Effectiveness of anti-TNFα for Crohn disease: research in a pediatric learning health system. Pediatrics 2014; 134:37-44. [PMID: 24935993 PMCID: PMC4531278 DOI: 10.1542/peds.2013-4103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES ImproveCareNow (ICN) is the largest pediatric learning health system in the nation and started as a quality improvement collaborative. To test the feasibility and validity of using ICN data for clinical research, we evaluated the effectiveness of anti-tumor necrosis factor-α (anti-TNFα) agents in the management of pediatric Crohn disease (CD). METHODS Data were collected in 35 pediatric gastroenterology practices (April 2007 to March 2012) and analyzed as a sequence of nonrandomized trials. Patients who had moderate to severe CD were classified as initiators or non-initiators of anti-TNFα therapy. Among 4130 patients who had pediatric CD, 603 were new users and 1211 were receiving anti-TNFα therapy on entry into ICN. RESULTS During a 26-week follow-up period, rate ratios obtained from Cox proportional hazards models, adjusting for patient and disease characteristics and concurrent medications, were 1.53 (95% confidence interval [CI], 1.20-1.96) for clinical remission and 1.74 (95% CI, 1.33-2.29) for corticosteroid-free remission. The rate ratio for corticosteroid-free remission was comparable to the estimate produced by the adult SONIC study, which was a randomized controlled trial on the efficacy of anti-TNFα therapy. The number needed to treat was 5.2 (95% CI, 3.4-11.1) for clinical remission and 5.0 (95% CI, 3.4-10.0) for corticosteroid-free remission. CONCLUSIONS In routine pediatric gastroenterology practice settings, anti-TNFα therapy was effective at achieving clinical and corticosteroid-free remission for patients who had Crohn disease. Using data from the ICN learning health system for the purpose of observational research is feasible and produces valuable new knowledge.
Collapse
Affiliation(s)
| | - Wallace V. Crandall
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - L. Charles Bailey
- Department of Pediatrics, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Marshall M. Joffe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard B. Colletti
- Department of Pediatrics, The University of Vermont College of Medicine, Burlington, Vermont
| | - Jeremy Adler
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Howard I. Baron
- Department of Pediatrics, University of Nevada School of Medicine, Pediatric Gastroenterology and Nutrition Associates, Las Vegas, Nevada
| | - James Berman
- Advocate Children's Hospital, UIC College of Medicine, Loyola University School of Medicine, Chicago, Illinois
| | - Fernando del Rosario
- Department of Pediatrics, Division of Pediatric Gastroenterology Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Andrew B. Grossman
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edward J. Hoffenberg
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Esther J. Israel
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Sandra C. Kim
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Peter A. Margolis
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, and
| | - Keith Marsolo
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Devendra I. Mehta
- Department of Pediatrics, Arnold Palmer Hospital for Children, Florida State University, Orlando, Florida
| | - David E. Milov
- Department of Pediatrics, Nemour’s Children’s Hospital, Orlando, Florida
| | - Ashish S. Patel
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, Children’s Medical Center, Dallas, Texas
| | - Jeanne Tung
- Department of Pediatric and Adolescent Medicine, Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; and
| | - Michael D. Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
31
|
Tursi A, Elisei W, Picchio M, Penna A, Lecca PG, Forti G, Giorgetti G, Faggiani R, Zampaletta C, Pelecca G, Brandimarte G. Effectiveness and safety of infliximab and adalimumab for ambulatory Crohn's disease patients in primary gastroenterology centres. Eur J Intern Med 2014; 25:485-90. [PMID: 24631020 DOI: 10.1016/j.ejim.2014.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Infliximab (IFX) and adalimumab (ADA) are the key treatments for Crohn's Disease (CD), unresponsive to standard treatments. Our aim was to compare the efficacy and safety of IFX and ADA in treating CD in clinical practice. METHODS One hundred and twenty-six patients (61 M, 65 F, mean age 36.2 years, range 19-67 years), affected by CD, were treated with infliximab (IFX, 59 patients) or adalimumab (ADA, 66 patients). Clinical efficacy, mucosal healing (MH), histological healing (HH), and safety were assessed. MH was defined complicated if healing of ulcers occurred with deformation of bowel profile and/or complete colonoscopy was impossible because of scars. RESULTS Patients were followed-up for 36 months. No difference was found between IFX and ADA in maintaining long-term clinical remission, MH and HH. Complicated MH was present in 17 (28.8%) patients in IFX group and in 7 (10.6%) patients in ADA group (p=0.012). In 9 (15.2%) patients in IFX group and 2 (3.0%) patients in ADA group colonoscopy was incomplete without cecal intubation or terminal ileum exploration (p=0.024). Side effects were similar in both groups. CONCLUSIONS Both IFX and ADA seem to be effective and safe in long-term outpatient treatment of CD in clinical practice.
Collapse
Affiliation(s)
- Antonio Tursi
- Gastroenterology Service, ASL BAT, Andria, BT, Italy.
| | - Walter Elisei
- Division of Gastroenterology, ASL Roma H, Albano Laziale, Rome, Italy
| | - Marcello Picchio
- Division of Surgery, "P. Colombo" Hospital, Velletri, Rome, Italy
| | - Antonio Penna
- Division of Gastroenterology, "San Paolo" Hospital, Bari, Italy
| | | | - Giacomo Forti
- Digestive Endoscopy Unit, "Santa Maria Goretti" Hospital, Latina, Italy
| | | | - Roberto Faggiani
- Division of Gastroenterology, "Belcolle Hospital", Viterbo, Italy
| | | | - Giorgio Pelecca
- Division of Gastroenterology, "Belcolle Hospital", Viterbo, Italy
| | | |
Collapse
|
32
|
Abstract
The etiology of inflammatory bowel disease (IBD), of which ulcerative colitis (UC) and Crohn’s disease (CD) are the two most prevailing entities, is unknown. However, IBD is characterized by an imbalanced synthesis of pro-inflammatory mediators of the inflamed intestine, and for more than a decade tumor necrosis factor-(TNF) α has been a major target for monoclonal antibody therapy. However, TNF inhibitors are not useful for one third of all patients (i.e. “primary failures”), and further one third lose effect over time (“secondary failures”). Therefore, other strategies have in later years been developed including monoclonal antibodies targeting the interleukin (IL)-6 family of receptors (the p40 subunit of IL-12/IL-23) as well as monoclonal antibodies inhibiting adhesion molecules (the α4β7 heterodimers), which direct leukocytes to the intestinal mucosa. Recently, small molecules, which are inhibitors of Janus kinases (JAKs), hold promise with a tolerable safety profile and efficacy in UC, and the field of nanomedicine is emerging with siRNAs loaded into polyactide nanoparticles that may silence gene transcripts at sites of intestinal inflammation. Thus, drug development for IBD holds great promise, and patients as well as their treating physicians can be hopeful for the future.
Collapse
Affiliation(s)
- Ole Haagen Nielsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen , Copenhagen , Denmark
| |
Collapse
|
33
|
Lee JK, Tang DH, Mollon L, Armstrong EP. Cost-effectiveness of biological agents used in ulcerative colitis. Best Pract Res Clin Gastroenterol 2013; 27:949-60. [PMID: 24182613 DOI: 10.1016/j.bpg.2013.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/19/2013] [Accepted: 09/24/2013] [Indexed: 02/08/2023]
Abstract
Ulcerative colitis (UC) produces bloody diarrhoea, severe abdominal pain, and need for clinic visits, hospitalizations, and surgeries. UC results in reduced health-related quality of life for patients and large direct medical and indirect costs for health systems and employers. Patients with the most severe disease require the most medical services, and these patients have larger costs than patients with mild or moderate disease. Despite biological therapies being quite expensive, they are indicated for patients unresponsive to initial standard therapies. Future hospitalizations may be reduced by starting a biological treatment. Cost-effectiveness results vary between countries, health systems, and model designs. Since restorative proctocolectomy can be curative, this surgery dominates biological therapy by being both less costly and more effective when measuring health system costs and patient quality-adjusted life years for 20 years. However the dose, duration, and effectiveness of biological treatments significantly impact estimates of their cost-effectiveness.
Collapse
Affiliation(s)
- Jeannie K Lee
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, 1295 N Martin Ave., Tucson, AZ 85721-0202, USA; Section of Geriatrics, Internal Medicine & Palliative Medicine, University of Arizona College of Medicine, 1295 N Martin Ave., Tucson, AZ 85721-0202, USA.
| | | | | | | |
Collapse
|
34
|
Abstract
Ulcerative colitis (UC) is a chronic idiopathic inflammatory disease of the gastrointestinal tract that affects the mucosal lining of the colon. Recent epidemiological data show that its incidence and prevalence are increasing in many parts of the world, in parallel with altered lifestyles, improved access to health, improved sanitation and industrialisation rates. Current therapeutic strategies for treating UC have only been moderately successful. Despite major recent advances in inflammatory bowel disease therapeutic resources, a considerable proportion of patients are still refractory to conventional treatment. Less than half of all patients achieve long-term remission, many require colectomy, and the disease still has a major impact on patients' lives. Moreover, recent data point to slightly raised mortality. While these outcomes could be partly improved by optimising current therapeutic strategies, they clearly highlight the need to develop new therapies. Currently, a number of promising and innovative therapeutic approaches are being explored, some of which will hopefully survive to reach the clinic. Until such a time arrives, it is important that a better understanding of the clinical particularities of the disease, an improved knowledge of the host-microbiome negative interactions and of the environmental factors beyond disease development is achieved to obtain the final and desired outcome: to provide better treatment and quality of life for patients with this disabling disease.
Collapse
Affiliation(s)
- Joana Torres
- Gastroenterology Service, Surgery Department, Hospital Beatriz Ângelo, , Loures, Portugal
| | | | | |
Collapse
|
35
|
Costa J, Magro F, Caldeira D, Alarcão J, Sousa R, Vaz-Carneiro A. Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2013; 19:2098-110. [PMID: 23860567 DOI: 10.1097/MIB.0b013e31829936c2] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND We systematically reviewed infliximab benefit in reducing hospitalizations and/or major surgery rates in patients with inflammatory bowel disease (IBD). METHODS A literature search to May 2012 was performed to identify all studies (experimental and observational) evaluating patients with IBD treated with infliximab and providing data on hospitalizations and/or major surgery rates. Three reviewers independently performed studies' selection, quality assessment, and data extraction. Analyses were carried according to study design (randomized clinical trials [RCTs] and observational studies) and IBD type (Crohn's disease [CD] and ulcerative colitis [UC]). Random-effects meta-analysis was used to derive pooled and 95% confidence intervals (CIs) estimates of odds ratios (OR). Heterogeneity was assessed with I test. RESULTS Twenty-seven eligible studies were included (9 RCTs and 18 observational studies). Infliximab reduced hospitalization risk, both in pooled RCTs (OR, 0.51; 95% CI 0.40-0.65; I = 0%) and results of observational studies (OR, 0.29, 95% CI, 0.19-0.43; I = 87%), without differences between CD and UC. Infliximab reduced surgery risk in pooled RCTs results, both in CD (OR, 0.31; 95% CI, 0.15-0.64; I = 0%) and UC (OR, 0.57; 95% CI, 0.37-0.88; I = 0%). Pooled estimate from observational studies favored infliximab for patients with CD (OR, 0.32; 95% CI, 0.21-0.49; I = 77%), but not for patients with UC. CONCLUSIONS The best evidence available points toward a reduction of the risk of hospitalization and major surgery requirement in patients with IBD treated with infliximab. This impact is clinically and economically relevant because hospitalization and surgery are considered to be markers of disease severity and significantly contribute to the total direct costs associated with IBD.
Collapse
|
36
|
Abstract
IMPORTANCE Treatment of Crohn disease is rapidly evolving, with the induction of novel biologic therapies and newer, often more intensive treatment approaches. Knowing how to treat individual patients in this quickly changing milieu can be a challenge. OBJECTIVE To review the diagnosis and management of moderate to severe Crohn disease, with a focus on newer treatments and goals of care. EVIDENCE REVIEW MEDLINE was searched from 2000 to 2011. Additional citations were procured from references of select research and review articles. Evidence was graded using the American Heart Association level-of-evidence guidelines. RESULTS Although mesalamines are still often used to treat Crohn disease, the evidence for their efficacy is lacking. Corticosteroids can be effectively used to induce remission in moderate to severe Crohn disease, but they do not maintain remission. The mainstays of treatment are immunomodulators and biologics, particularly anti-tumor necrosis factor. CONCLUSION AND RELEVANCE Immunomodulators and biologics are now the preferred treatment options for Crohn disease.
Collapse
Affiliation(s)
- Adam S Cheifetz
- Division of Gastroenterology, Rabb-Rose 425, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
| |
Collapse
|
37
|
Urbano APS, Sassaki LY, Dorna MS, Carvalhaes MADBL, Martini LA, Ferreira ALA. Nutritional intake according to injury extent in ulcerative colitis patients. J Hum Nutr Diet 2013; 26:445-51. [PMID: 23560822 DOI: 10.1111/jhn.12064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) is often associated with nutritional deficiency, which appears to contribute to the progression of UC severity. The present study aimed to evaluate nutritional status and dietary intake in UC remission patients. METHODS The present study comprised a cross-sectional study in which variables such as extent of disease (distal colitis, left-sided colitis, pancolitis), remission period, sex and age were recorded. Extent of disease was assessed by the results of a colonoscopy and dietary intake was evaluated by using 3-day, 24-h recalls. A Kruskall-Wallis test was used to compare the intake of macro- and micronutrients among the three study groups. The analysis was complemented by the Mann-Whitney test. A logistic regression analysis was performed to identify predictive factors of extent of disease (pancolitis versus left-sided colitis versus distal colitis). RESULTS The median (range) age of the 59 patients was 49.0 (37.0-63.0) years and 53.3% were female. Twenty-six (44.1%) patients had distal colitis, 11 (18.6%) patients had left-sided colitis and 22 (37.3%) patients had pancolitis. A high probability of an inadequate intake of fibre (100%), fat soluble vitamins (>40% for vitamin A and >95% for vitamin E), vitamin C (>34%), calcium (>90%) and magnesium (>50%) was identified in the study group. Vitamin D intake (odds ratio = 0.60; 95% confidence interval = 0.39-0.94; P < 0.05) was significantly associated with increased intestinal damage. CONCLUSIONS A large number of individuals showed an inadequate intake of nutrients. In addition, the consumption of vitamin D was significantly associated with extent of disease.
Collapse
Affiliation(s)
- A P S Urbano
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | | | | | | | | | | |
Collapse
|
38
|
Siebert U, Wurm J, Gothe RM, Arvandi M, Vavricka SR, von Känel R, Begré S, Sulz MC, Meyenberger C, Sagmeister M; Swiss IBD Cohort Study Group. Predictors of temporary and permanent work disability in patients with inflammatory bowel disease: results of the swiss inflammatory bowel disease cohort study. Inflamm Bowel Dis 2013; 19:847-55. [PMID: 23446333 DOI: 10.1097/MIB.0b013e31827f278e] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammatory bowel disease can decrease the quality of life and induce work disability. We sought to (1) identify and quantify the predictors of disease-specific work disability in patients with inflammatory bowel disease and (2) assess the suitability of using cross-sectional data to predict future outcomes, using the Swiss Inflammatory Bowel Disease Cohort Study data. METHODS A total of 1187 patients were enrolled and followed up for an average of 13 months. Predictors included patient and disease characteristics and drug utilization. Potential predictors were identified through an expert panel and published literature. We estimated adjusted effect estimates with 95% confidence intervals using logistic and zero-inflated Poisson regression. RESULTS Overall, 699 (58.9%) experienced Crohn's disease and 488 (41.1%) had ulcerative colitis. Most important predictors for temporary work disability in patients with Crohn's disease included gender, disease duration, disease activity, C-reactive protein level, smoking, depressive symptoms, fistulas, extraintestinal manifestations, and the use of immunosuppressants/steroids. Temporary work disability in patients with ulcerative colitis was associated with age, disease duration, disease activity, and the use of steroids/antibiotics. In all patients, disease activity emerged as the only predictor of permanent work disability. Comparing data at enrollment versus follow-up yielded substantial differences regarding disability and predictors, with follow-up data showing greater predictor effects. CONCLUSIONS We identified predictors of work disability in patients with Crohn's disease and ulcerative colitis. Our findings can help in forecasting these disease courses and guide the choice of appropriate measures to prevent adverse outcomes. Comparing cross-sectional and longitudinal data showed that the conduction of cohort studies is inevitable for the examination of disability.
Collapse
|
39
|
|
40
|
|
41
|
Kelley-Quon LI, Tseng CH, Jen HC, Ziring DA, Shew SB. Postoperative complications and health care use in children undergoing surgery for ulcerative colitis. J Pediatr Surg 2012; 47:2063-70. [PMID: 23163999 DOI: 10.1016/j.jpedsurg.2012.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/02/2012] [Accepted: 07/02/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Medical and surgical approaches toward children with ulcerative colitis (UC) vary and have differing implications for health care use. The goal of this study was to define hospital use and complications for children with UC before and after staged restorative proctocolectomy. PATIENTS AND METHODS A retrospective study of the California Patient Discharge Dataset from 1999 to 2007 of children aged 2 to 18 years with UC who underwent colectomy was performed (N = 218). Surgical staging was determined alongside hospital type (children's vs non-children's) and surgical case volume. Postoperative complications and hospital length of stay were analyzed using multivariate regression. RESULTS The cohort was mostly male (56%) and white (80%), had private insurance (78%), and underwent colectomy at a children's hospital (62%). Overall, 65% required a separate hospital admission before admission for colectomy. Single-, 2-, and 3-stage procedures were performed in 19 (9%), 144 (66%), and 38 (17%) children. The mean admissions per patient were 1.8 ± 2.4 before colectomy and 0.7 ± 1.6 after surgical completion. Surgical complications occurred in 100 (49%) children, with 39% being attributed to postoperative infection. Children with public insurance (odds ratio, 2.18; 95% confidence interval, 1.0-4.85) and those who underwent colectomy at a non-children's hospital (odds ratio, 2.53; 95% confidence interval, 1.0-6.37) had increased likelihood of surgical complications. Finally, nonwhite race, surgical staging, and undergoing colectomy at a low- or medium-volume hospital resulted in prolonged hospitalization (P < .05). CONCLUSIONS Children with UC who undergo colectomy use a large number of hospital resources before surgery and exhibit decreased hospital use after surgical completion. Children undergoing colectomy at children's and high-volume hospitals experience fewer surgical complications and shorter hospitalization.
Collapse
Affiliation(s)
- Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7098, USA
| | | | | | | | | |
Collapse
|
42
|
Hinojosa J, Gisbert JP, Gomollón F, López San Román A. Adherence of gastroenterologists to European Crohn's and Colitis Organisation consensus on Crohn's disease: a real-life survey in Spain. J Crohns Colitis 2012; 6:763-70. [PMID: 22398092 DOI: 10.1016/j.crohns.2011.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/28/2011] [Accepted: 12/29/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no information as to the extent by which Spanish gastroenterologists adhere to Crohn's disease (CD) management guidelines. The objective of this study was to evaluate the degree of adherence of Spanish gastroenterologists to the European Crohn's and Colitis Organisation (ECCO) guidelines and to determine whether differences in adherence exist between gastroenterologists specialized in inflammatory bowel diseases (GSIBDs) and general gastroenterologists (GGs). METHODS This was a prospective, nation-wide, questionnaire-based survey covering aspects related to diagnosis, treatment, follow-up, and safety considered by the physicians in their daily management of CD, as well as demographic traits seen in clinical practice. RESULTS The overall degree of adherence to guidelines by both GSIBDs and GGs was high. However, the use of imaging techniques in diagnosis, follow-up, and in relapsed patients differed between the two groups. In the diagnosis of perianal disease, GSIBDs used magnetic resonance and surgical exploration under anesthesia more frequently than GGs. In terms of therapeutic choices, the adherence to guidelines was good in both groups. However, GSIBDs showed significantly higher adherence in some areas: thiopurines were used less in refractory cases and methotrexate was used more commonly in corticoid-dependent, azathioprine-intolerant patients, and in patients under biological treatment. Request for infection studies and vaccinations at diagnosis or prior to treatment was more common among GSIBDs. CONCLUSIONS Guideline adherence among Spanish gastroenterologists is high. However, there are significant differences between IBD-specialized (more adherent in general) and non-specialized gastroenterologists.
Collapse
Affiliation(s)
- J Hinojosa
- Departamento de Gastroenterología, Hospital de Manises, Valencia, Spain
| | | | | | | |
Collapse
|
43
|
Biondi A, Zoccali M, Costa S, Troci A, Contessini-Avesani E, Fichera A. Surgical treatment of ulcerative colitis in the biologic therapy era. World J Gastroenterol 2012; 18:1861-70. [PMID: 22563165 PMCID: PMC3337560 DOI: 10.3748/wjg.v18.i16.1861] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 11/25/2011] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis, biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease. The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven. Furthermore, these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications. Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients. Surgery is traditionally recommended as salvage therapy when medical management fails, and, despite advances in medical therapy, colectomy rates remain unchanged between 20% and 30%. To overcome the reported increase in postoperative complications in patients on biologic therapies, several surgical strategies have been developed to maintain long-term pouch failure rate around 10%, as previously reported. Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.
Collapse
|
44
|
Abstract
BACKGROUND Dose intensification is a common approach to treat Crohn's disease (CD) patients who lose response to infliximab maintenance therapy. Few studies have reported upon its long-term efficacy or predictors of response. AIM The goal of this study is to investigate durability and predictors of response to dose intensification-including method of dose intensification, combination immunomodulator therapy, and premedication with intravenous hydrocortisone. METHODS We performed a retrospective study of dose-intensified CD patients at our institution. Dose intensification was defined as an increase in dose from 5 to 10 mg/kg, an increase in frequency of infusions from every 8 weeks to every 6 weeks or less, or both an increase in dose and frequency. RESULTS Thirty CD patients (mean age, 39.9 years) met study criteria and underwent dose intensification. Ten (33.3%) patients remained on dose intensification at the end of our study or returned to their former infliximab dose or schedule (median follow-up, 41 months). Fourteen patients (46.7%) eventually lost response to dose intensification, but dose intensification extended infliximab therapy by a median duration of 9 months. Six patients (20%) didn't respond to dose intensification. Neither method of dose intensification, combination immunomodulator therapy, nor premedication with intravenous hydrocortisone predicted initial or durable response to dose intensification. However, analysis of predictors was limited by the small sample size of our study. CONCLUSIONS The majority of CD patients respond to dose intensification, and a substantial portion will experience durable response such that infliximab therapy is successfully extended by one or more years.
Collapse
Affiliation(s)
- Kirk K Lin
- Division of Gastroenterology, Department of Internal Medicine, University of California at San Francisco, San Francisco, CA, USA.
| | | | | | | |
Collapse
|
45
|
Abstract
Inflammatory bowel diseases (IBD), namely Crohn's disease and ulcerative colitis, are burdened by high medical costs which are mostly dependent on hospital inpatient treatment. New biologic therapies, which target specific cytokines in the inflammatory cascade leading to the intestinal lesions, including tumor necrosis factor (TNF)-α, have revolutionized the management of IBD by offering a therapeutic chance to patients in whom conventional therapies failed. However, the relatively high costs of biologic drugs, together with their potential toxicity due to infections and malignancies, have led to debate regarding their indiscriminate use in IBD patients. The purpose of this review is to deal with the optimal use and cost-effectiveness of the two main monoclonal anti-TNF-α agents currently used in the management of IBD patients, i.e. the chimeric human/murine antibody infliximab and the fully human antibody adalimumab.
Collapse
Affiliation(s)
- Antonio Di Sabatino
- First Department of Medicine, Centro per lo Studio e la Cura delle Malattie Infiammatorie Croniche intestinali, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
| | | | | | | | | |
Collapse
|
46
|
Ghosh S. Estimating benefits of therapy in Crohn's disease in terms of indirect costs. Can J Gastroenterol 2011; 25:412. [PMID: 21912764 DOI: 10.1155/2011/310417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
47
|
Buchanan J, Wordsworth S, Ahmad T, Perrin A, Vermeire S, Sans M, Taylor J, Jewell D. Managing the long term care of inflammatory bowel disease patients: The cost to European health care providers. J Crohns Colitis 2011; 5:301-16. [PMID: 21683300 DOI: 10.1016/j.crohns.2011.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory Bowel Disease (which includes Crohn's Disease and Ulcerative Colitis), is a chronic condition characterised by substantial morbidity. Inflammatory Bowel Disease patients are considered expensive to manage, hence accurate estimates of care costs are crucial to help healthcare providers plan clinical management. The aim of this study is to estimate the cost of care for Crohn's Disease and Ulcerative Colitis patients in the United Kingdom and Western mainland Europe. METHODS Decision models were built to simulate the natural disease history of Crohn's Disease and Ulcerative Colitis, informed by United Kingdom and European clinical pathways. A healthcare provider perspective was adopted, model inputs were informed by published sources and expert opinion, and UK healthcare costs were used (2008 prices). Cohorts of 25 year old patients presenting with symptoms of varying severity were modelled over ten years, and annual treatment costs calculated per patient. RESULTS The average annual cost of care per Crohn's Disease/Ulcerative Colitis patient was £631/£762 (United Kingdom) and £838/£796 (Europe). Most costs were incurred immediately following diagnosis, particularly in European Crohn's patients, reflecting the earlier use of more aggressive treatments. Surgery, hospitalisation, and the use of biological therapies and mesalazine (in Ulcerative Colitis) were key cost drivers. The total annual cost to the United Kingdom National Health Service of caring for Inflammatory Bowel Disease patients was estimated to be £131million. CONCLUSIONS This study confirms that Inflammatory Bowel Disease patients are expensive to manage and illustrates the importance of differentiating between alternative clinical management scenarios.
Collapse
Affiliation(s)
- James Buchanan
- Health Economics Research Centre, University of Oxford, Oxford, UK.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Prenzler A, Bokemeyer B, von der Schulenburg JM, Mittendorf T. Health care costs and their predictors of inflammatory bowel diseases in Germany. Eur J Health Econ 2011; 12:273-83. [PMID: 20967482 DOI: 10.1007/s10198-010-0281-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 10/01/2010] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Detailed cost studies of inflammatory bowel diseases (IBD) for Germany are limited. Aim of this study was to collect resource-use data related to IBD via a cross-sectional study, to quantify these from the perspective of the Statutory Health Insurance (SHI) and to identify cost-driving factors. METHODS Patients with Crohn's disease (CD) or ulcerative colitis (UC) from 24 gastroenterological specialists' practices and two hospitals were enrolled in an internet-based database between March 2006 and July 2007. Outpatient services, inpatient visits as well as medication usage were recorded and evaluated from the perspective of the SHI for 2007. Disease severity was measured by the Crohn's Disease Activity Index (CDAI) and the Colitis Activity Index (CAI), respectively. Extensive statistical analyses including generalized linear modeling (gamma model with the log link) to identify cost-driving factors were performed. RESULTS Data from 1,030 patients with IBD (CD: 511; UC: 519) were collected. On average a patient with CD incurs annual costs of EUR 3,767 (± 5,895 (SD)) (among those 68.5% medication; 20.5% inpatient) and an average patient with UC incurs EUR 2,478 (± 4,591) (74% medication; 10% inpatient), whereas 10% of the patient with IBD account for 49% (CD: 50%; UC: 46%) of the costs. The regression analysis showed that especially the use of TNF-alpha-inhibitors, inpatient stays, gender as well as the severity status has a significant influence on costs. Further disease-specific impact factors were identified. CONCLUSIONS This is the first study to calculate costs due to CD and UC from the perspective of the SHI in Germany and to identify cost-driving factors. It confirms a high economic burden of IBD to payers and society.
Collapse
Affiliation(s)
- Anne Prenzler
- Leibniz University Hannover, Center for Health Economics, Koenigsworther Platz 1, 30167, Hannover, Germany.
| | | | | | | |
Collapse
|
49
|
Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K. A nationwide analysis of changes in severity and outcomes of inflammatory bowel disease hospitalizations. J Gastrointest Surg 2011; 15:267-76. [PMID: 21108015 DOI: 10.1007/s11605-010-1396-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 11/12/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The past decade has seen a change in inflammatory bowel disease (IBD; Crohn's disease (CD) and ulcerative colitis (UC)) treatment, with increasing use of immunomodulators and biologics. The impact of this on IBD hospitalization outcomes is unknown. METHODS We identified hospitalizations with a diagnosis of IBD using data from the Nationwide Inpatient Sample, a national US discharge database. We compared the proportion of hospitalizations resulting in surgery in the entire cohort and within each disease severity stratum for the years 1998, 2004, and 2007. RESULTS There were an estimated 89,673 hospitalizations for CD in 1998 increasing to 150,593 hospitalizations in 2007. UC hospitalizations increased from 56,911 in 1998 to 86,611 in 2007. This increase was primarily among low or intermediate severity hospitalizations not requiring surgery. For CD, the proportion of bowel surgeries during hospitalization decreased from 17.3% in 1998 to 12.4% in 2007 (p < 0.001) while for UC, the proportion of colectomy decreased from 9.5% in 1998 to 6.2% in 2007 (p < 0.001). For both diagnoses, this reduction was significant in those with a low severity of disease but not with in those with the highest severity stratum. CONCLUSIONS There continues to be an increase in the number of hospitalizations in patients with IBD. The numbers of non-elective bowel surgeries among those with the highest severity of disease continues to increase suggesting need for further research into improving outcomes in this cohort at high risk for adverse outcome.
Collapse
|
50
|
|