*Department of Medicine, McGill University, Montreal, Quebec, Canada; †Division of Colorectal Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada; ‡Department of Surgery, McGill University, Montreal, Quebec, Canada; §Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; ‖Department of Medicine, Division of Gastroenterology, McGill University, Montreal, Quebec, Canada; and ¶Department of Medicine, Division of clinical Epidemiology, McGill University, Montreal, Quebec, Canada.
Inflamm Bowel Dis. 2017 Aug;23(8):1262-1271. doi: 10.1097/MIB.0000000000001147.
Ulcerative colitis (UC) is associated with significant health care utilization and costs. We assessed UC direct medical costs in Quebec, Canada, in 2 time periods (1998-2004 and 2005-2011) and determined changes over time.
Because the introduction of anti-tumor necrosis factor α may have influenced the UC cost, we used the Quebec health services administrative databases and the same inclusion criteria to create 2 separate UC cohorts, before (1998-2004) and after (2005-2011) anti-tumor necrosis factor α introduction.
The postcohort included 801 patients and the precohort 716 patients. Overall, cohorts were predominately women and were comparable in terms of patient's demographics and comorbidities. Corticosteroid use, emergency department visits and hospitalizations for colectomies, and other gastrointestinal disorders were fewer in the postcohort versus precohort. The median daily cost (interquartile range) was $16.96 ($6.80-$48.16) for the postcohort and $18.65 ($7.82-$53.31) for the precohort. In generalized linear models with log link and gamma distribution, the adjusted daily cost ratios (95% confidence interval) in the postcohort versus precohort was 0.75 (0.67-0.85). Older age at inclusion, low income, lower socioeconomic status, and previous use of gastroprotective agents, antidepressants, and sulfasalazine, methotrexate, or cyclosporine were associated with increased costs. Women and those who visited a gastroenterologist in the previous year incurred lower costs.
The mean UC daily cost decreased from 2005 to 2011 as compared to 1998 to 2004 because of a decrease in rates of colectomy and other gastrointestinal hospitalizations and emergency department visits. Further investigation is required to determine the reasons for these changes.
溃疡性结肠炎（UC）与大量的医疗保健利用和成本有关。我们评估了加拿大魁北克省的溃疡性结肠炎直接医疗成本，在两个时间段（1998-2004 年和 2005-2011 年），并确定了随时间的变化。
由于抗肿瘤坏死因子-α的引入可能影响了 UC 的成本，我们使用魁北克省的卫生服务行政数据库，并采用相同的纳入标准，创建了两个单独的 UC 队列，分别在抗肿瘤坏死因子-α引入之前（1998-2004 年）和之后（2005-2011 年）。
后队列包括 801 例患者，前队列包括 716 例患者。总体而言，队列主要为女性，在患者人口统计学和合并症方面具有可比性。与前队列相比，后队列的皮质类固醇使用率、急诊就诊率和因结肠切除术以及其他胃肠道疾病住院率较低。后队列的中位日费用（四分位距）为 16.96 加元（6.80-48.16），前队列为 18.65 加元（7.82-53.31）。在对数链接和伽马分布的广义线性模型中，后队列与前队列的调整后日费用比（95%置信区间）为 0.75（0.67-0.85）。纳入时年龄较大、收入较低、社会经济地位较低、以及之前使用胃保护剂、抗抑郁药和柳氮磺胺吡啶、甲氨蝶呤或环孢素与费用增加有关。女性和前一年就诊过胃肠病专家的患者费用较低。
与 1998 年至 2004 年相比，2005 年至 2011 年 UC 的平均日费用降低，原因是结肠切除术和其他胃肠道住院和急诊就诊的发生率降低。需要进一步调查以确定这些变化的原因。
