Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University, Beer Sheva, Israel.
Aliment Pharmacol Ther. 2010 Apr;31(7):735-44. doi: 10.1111/j.1365-2036.2009.04228.x. Epub 2009 Dec 29.
Forecasting clinical and economic outcomes in ulcerative colitis (UC) and Crohn's disease (CD) patients is complex, but necessary.
To determine: the frequency of treatment-classified clinical states; the probability of transition between states; and the economic outcomes.
Newly diagnosed UC and CD patients, allocated into seven clinical states by medical and surgical treatments recorded in serial 3-month cycles, underwent Markov analysis.
Over 10 years, 630 UC and 318 CD patients had 22,823 and 11,871 cycles. The most frequent clinical outcomes were medical/surgical remission (medication-free) and mild disease (on 5-aminosalicylates, antibiotics, topical corticosteroids), comprising 28% and 62% of UC cycles and 24% and 51% of CD cycles respectively. The probability of drug-response in patients receiving systemic corticosteroids/immunomodulators was 0.74 in UC, 0.66 in CD. Both diseases had similar likelihood of persistent drug-dependency or drug-refractoriness. Surgery was more probable in CD, 0.20, than UC, 0.08. In terms of economic outcomes, surgery was costlier in UC per cycle, but the outlay over 10 years was greater in CD. Drug-refractory UC and CD cases engendered high costs in the cohort.
Most patients on 5-aminosalicylates, corticosteroids and immunomodulators had favourable clinical and economic outcomes over 10 years. Drug-refractory and surgical patients exhibited greater long-term expenses.
预测溃疡性结肠炎（UC）和克罗恩病（CD）患者的临床和经济结局较为复杂，但十分必要。
确定：治疗分类的临床状态的频率；状态之间的转换概率；以及经济结果。
新诊断的 UC 和 CD 患者，根据医疗和手术治疗记录，在连续的 3 个月周期中分配到七个临床状态，进行马尔可夫分析。
在 10 年内，630 名 UC 和 318 名 CD 患者经历了 22823 和 11871 个周期。最常见的临床结局是医学/手术缓解（无药物治疗）和轻度疾病（使用 5-氨基水杨酸、抗生素、局部皮质类固醇），占 UC 周期的 28%和 CD 周期的 62%。接受全身皮质类固醇/免疫调节剂治疗的患者药物反应的概率分别为 UC 的 0.74 和 CD 的 0.66。两种疾病持续依赖药物或药物耐药的可能性相似。CD 患者手术的可能性更大，为 0.20，而 UC 患者为 0.08。就经济结果而言，UC 患者每周期手术的成本更高，但在 10 年内的支出更高。CD 患者中药物难治性 UC 和 CD 病例导致队列的高成本。
大多数使用 5-氨基水杨酸、皮质类固醇和免疫调节剂的患者在 10 年内具有良好的临床和经济结局。药物难治性和手术患者表现出更高的长期费用。
