Ui-Haq Zia, Causin Luiz, Kamalati Tahereh, Kahol Durgesh, Vaikunthanathan Trishan, Wong Charlotte, Arebi Naila
Imperial College Health Partners, London, UK.
Janssen-Cilag Ltd, High Wycombe, UK.
BMC Gastroenterol. 2024 Dec 30;24(1):480. doi: 10.1186/s12876-024-03559-3.
With 20-40% of patients who have inflammatory bowel disease (IBD) not responding to therapy, resource use and costs can be high. We performed a descriptive analysis of health-care data for IBD management in the National Health Service to explore potential areas for improvement.
In this exploratory study, we analysed real-world data from the Discover dataset for adults with a diagnosis of incident IBD recorded in northwest London, UK, between 31 March, 2016, and 31 March, 2020. We compared mean visit numbers and primary and secondary care costs per patient to examine resource use and costs for active disease versus remission.
We included 7,733 patients (5,872 with ulcerative colitis [UC], 1,427 with Crohn's disease [CD], and 434 with codes for both [termed IBD-undefined in this study]). Remission was recorded in 19,218 (82%) of 23,488 observations for UC, 4,686 (82%) of 5,708 for CD, and 1,122 (65%) for IBD-undefined observations. Health-care resource use was significantly higher with active disease in all settings except primary care for UC. Total health-care costs were greater with active disease than remission for all diagnoses (all p < 0.0001). The main driver of costs was inpatient hospital care among those with active disease; elective inpatient costs were high among patients with UC and IBD-undefined in remission.
Higher health-care resource use and costs were observed with active disease, which underscores the importance of early induction and maintenance of remission in UC and CD. Updated strategies that incorporate treat to target may offer cost benefits by the offsetting of biologic drug costs with a reduction in costly inpatient hospital stays.
This trial was not registered as it used pseudonymised retrospective data.
20%-40%的炎症性肠病（IBD）患者对治疗无反应，资源利用和成本可能很高。我们对国民保健制度中IBD管理的医疗保健数据进行了描述性分析，以探索潜在的改进领域。
在这项探索性研究中，我们分析了2016年3月31日至2020年3月31日期间英国伦敦西北部记录的确诊为新发IBD的成年人的Discover数据集的真实世界数据。我们比较了每位患者的平均就诊次数以及初级和二级医疗保健成本，以检查活动性疾病与缓解期的资源利用和成本情况。
我们纳入了7733名患者（5872例溃疡性结肠炎[UC]、1427例克罗恩病[CD]和434例两者编码均有的患者[本研究中称为IBD-未明确类型]）。在UC的23488次观察中有19218次（82%）记录为缓解，CD的5708次观察中有4686次（82%），IBD-未明确类型观察中有1122次（65%）。除UC的初级医疗保健外，在所有情况下，活动性疾病的医疗保健资源利用均显著更高。所有诊断中，活动性疾病的总医疗保健成本均高于缓解期（所有p<0.0001）。成本的主要驱动因素是活动性疾病患者的住院治疗；缓解期的UC和IBD-未明确类型患者的择期住院成本较高。
观察到活动性疾病的医疗保健资源利用和成本更高，这凸显了在UC和CD中早期诱导和维持缓解的重要性。纳入达标治疗的更新策略可能通过用减少昂贵的住院天数来抵消生物药物成本从而带来成本效益。
本试验未注册，因为使用了化名的回顾性数据。
