接受英夫利昔单抗或早期结肠切除术的急性重症溃疡性结肠炎患者的长期医疗利用和成本比较。
A comparison of long-term healthcare utilization and costs in patients with acute severe ulcerative colitis receiving infliximab early colectomy.
作者信息
Vasudevan Abhinav, Arachchi Asiri, Scanlon Cian, Greenhalgh Jarrod, Van Langenberg Daniel R
机构信息
Department of Gastroenterology and Hepatology, Eastern Health, Level 2, 5 Arnold Street, Box Hill Hospital, Box Hill, Victoria, 3128, Australia.
Department of Gastroenterology and Hepatology, Eastern Health, Victoria, Australia.
出版信息
Ther Adv Chronic Dis. 2019 Jan 29;10:2040622319825595. doi: 10.1177/2040622319825595. eCollection 2019.
BACKGROUND
Early intervention for acute severe ulcerative colitis (ASUC) improves outcomes. Outcomes and healthcare costs for an infliximab-first and colectomy-first approach were compared.
METHODS
This single-center retrospective cohort study of inpatients with steroid-refractory ASUC who received infliximab 5 mg/kg (1-3 doses without maintenance) or initial colectomy between 2004 and 2014 assessed long-term healthcare utilization and direct costs following infliximab or colectomy, using admission coding data until 31 December 2016.
RESULTS
A total of 118 patients received either infliximab ( = 85, 72%) or colectomy ( = 33, 28%) as initial therapy, with 35(41%) patients eventually requiring colectomy post-infliximab (median 213 days, range [6, 3739]). Median follow up was 7 years [0, 14]. Following infliximab for ASUC, 44% of patients then received antitumor necrosis factor maintenance. After ASUC therapy, length of stay and number of admissions did not significantly differ between groups but higher numbers of complications prompting readmission occurred in the colectomy group (median 4 1, < 0.001). There were no differences in admissions or total length of stay for patients who had received infliximab first then colectomy those treated with colectomy first (median 7.0 4.0, 41.5 days 29 days, respectively, each > 0.05). Total costs were lower at 6 months (mean AUD17,662 AUD24,852, = 0.003), yet were similar at 7 years following an infliximab compared with colectomy approach (AUD72,834 AUD59,557, = 0.23). After infliximab, costs were significantly higher at 7 years with biologic rather than immunomodulator-only maintenance therapy (AUD109,365 AUD47,842, < 0.01).
CONCLUSIONS
In support of current practice, infliximab salvage in steroid-refractory ASUC achieved reduced short-term healthcare costs compared with initial colectomy, though long-term costs were not significantly different.
背景
对急性重症溃疡性结肠炎（ASUC）进行早期干预可改善预后。比较了英夫利昔单抗优先和结肠切除术优先两种治疗方法的预后及医疗费用。
方法
本单中心回顾性队列研究纳入了2004年至2014年间接受英夫利昔单抗5mg/kg（1 - 3剂，无维持治疗）或初次结肠切除术的类固醇难治性ASUC住院患者，利用截至2016年12月31日的入院编码数据评估英夫利昔单抗或结肠切除术后的长期医疗利用情况和直接费用。
结果
共有118例患者接受英夫利昔单抗（n = 85，72%）或结肠切除术（n = 33，28%）作为初始治疗，其中35例（41%）患者在接受英夫利昔单抗治疗后最终需要进行结肠切除术（中位时间213天，范围[6, 3739]）。中位随访时间为7年[0, 14]。英夫利昔单抗治疗ASUC后，44%的患者随后接受了抗肿瘤坏死因子维持治疗。ASUC治疗后，两组之间的住院时间和入院次数无显著差异，但结肠切除术组因并发症导致再次入院的人数较多（中位值4 vs 1，P < 0.001）。先接受英夫利昔单抗治疗后再进行结肠切除术的患者与先进行结肠切除术的患者在入院次数或总住院时间方面无差异（分别为中位值7.0 vs 4.0，41.5天 vs 29天，P均> 0.05）。6个月时的总费用较低（平均澳元17,662 vs澳元24,852，P = 0.003），但英夫利昔单抗治疗组与结肠切除术组在7年后的费用相似（澳元72,834 vs澳元59,557，P = 0.23）。英夫利昔单抗治疗后，7年时使用生物制剂而非仅使用免疫调节剂进行维持治疗的费用显著更高（澳元109,365 vs澳元47,842，P < 0.01）。
结论
为支持当前的治疗实践，对于类固醇难治性ASUC，英夫利昔单抗挽救治疗与初次结肠切除术相比，短期医疗费用降低，尽管长期费用无显著差异。
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