*Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, Tennessee; †AbbVie Inc., North Chicago, Illinois; and ‡Novosys Health, Green Brook, New Jersey.
Inflamm Bowel Dis. 2017 Oct;23(10):1860-1866. doi: 10.1097/MIB.0000000000001243.
Fistulas are a common and often debilitating complication of Crohn's disease (CD). Tumor necrosis factor inhibitors and/or seton drainage are effective treatment options. We compared health care utilization and costs for patients with perianal CD who had setons placed before treatment with biologics versus those who did not.
Patients with CD (≥18 yr) were identified from the Truven Health MarketScan Database by ICD-9 code 555.x (January 1, 2006-March 31, 2015); those with external fistulas were identified by ICD-9 codes 565.1. Biological treatment and seton procedures were identified with the National Drug Codes or Current Procedural Terminology codes. Patients were grouped into 2 cohorts: seton before biological (SBB) treatment or no seton before biological (NSBB) treatment.
SBB (N = 326) and NSBB (N = 1519) groups were similar in baseline age, sex, use of immunosuppressants and steroids, and comorbidity score. Baseline prevalence of asthma and cardiovascular disease, and use of antibiotics and 5-aminosalicylic acid were significantly greater in the SBB group versus the NSBB group. Baseline number of all-cause and fistula-related hospitalizations were greater for the SBB group than in the NSBB group. However, during follow-up, the NSBB group required significantly more hospitalizations than the SBB group (all-cause: 0.41 versus 0.23; fistula related: 0.16 versus 0.07) and had significantly greater health care costs (all-cause: $9711 versus $5514; fistula related: $4156 versus $1900). Results were confirmed in multivariate regressions adjusting for baseline characteristics and prescription drug use.
Patients who had the setons placed before treatment with biologics used fewer health care resources and incurred lower health care costs compared with those who did not have the procedure.
瘘管是克罗恩病（CD）的一种常见且常使人虚弱的并发症。肿瘤坏死因子抑制剂和/或挂线引流是有效的治疗选择。我们比较了接受生物制剂治疗前放置挂线与未放置挂线的肛周 CD 患者的医疗保健利用和成本。
通过 ICD-9 代码 555.x（2006 年 1 月 1 日至 2015 年 3 月 31 日）从 Truven Health MarketScan 数据库中确定 CD 患者（≥18 岁）；通过 ICD-9 代码 565.1 确定有外部瘘管的患者。生物治疗和挂线程序的识别使用国家药物代码或当前程序术语代码。患者分为两组：生物治疗前挂线（SBB）治疗或生物治疗前无挂线（NSBB）治疗。
SBB（N=326）和 NSBB（N=1519）组在基线年龄、性别、免疫抑制剂和类固醇的使用以及合并症评分方面相似。SBB 组与 NSBB 组相比，基线时哮喘和心血管疾病的患病率以及抗生素和 5-氨基水杨酸的使用率明显更高。SBB 组的全因和瘘管相关住院人数明显高于 NSBB 组。然而，在随访期间，NSBB 组的住院次数明显多于 SBB 组（全因：0.41 对 0.23；瘘管相关：0.16 对 0.07），且医疗保健费用明显更高（全因：9711 美元对 5514 美元；瘘管相关：4156 美元对 1900 美元）。在调整基线特征和处方药使用的多变量回归中，结果得到证实。
与未接受该手术的患者相比，在接受生物制剂治疗前放置挂线的患者使用的医疗资源更少，医疗保健费用也更低。
