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Abstract
Objective Ulcerative colitis (UC) is a lifelong, relapsing-remitting disease. Patients non-responsive to pharmacological treatment may require a colectomy. We estimated pre-colectomy and post-colectomy healthcare resource utilisation (HCRU) and costs in England.
Design/Method A retrospective, longitudinal cohort study indexing adult patients with UC undergoing colectomy (2009–2015), using linked Clinical Practice Research Datalink/Hospital Episode Statistics data, was conducted. HCRU, healthcare costs and pharmacological treatments were evaluated during 12 months prior to and including colectomy (baseline) and 24 months post-colectomy (follow-up; F-U), comparing baseline/F-U, emergency/elective colectomy and subtotal/full colectomy using descriptive statistics and paired/unpaired tests.
Results 249 patients from 26 165 identified were analysed including 145 (58%) elective and 184 (74%) full colectomies. Number/cost of general practitioner consultations increased post-colectomy (p<0.001), and then decreased at 13–24 months (p<0.05). From baseline to F-U, the number of outpatient visits, number/cost of hospitalisations and total direct healthcare costs decreased (all p<0.01). Postoperative HCRU was similar between elective and emergency colectomies, except for the costs of colectomy-related hospitalisations and medication, which were lower in the elective group (p<0.05). Postoperative costs were higher for subtotal versus full colectomies (p<0.001). At 1–12 month F-U, 30%, 19% and 5% of patients received aminosalicylates, steroids and immunosuppressants, respectively.
Conclusion HCRU/costs increased for primary care in the first year post-colectomy but decreased for secondary care, and varied according to the colectomy type. Ongoing and potentially unnecessary pharmacological therapy was seen in up to 30% of patients. These findings can inform patients and decision-makers of potential benefits and burdens of colectomy in UC.
- ulcerative colitis
- colorectal surgery
- health economics
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Footnotes
Contributors JCC, MDD, NB, RM and DB were involved in the conception and design of the study, analysis and interpretation of data, revising the article critically for important intellectual content, and final approval of the version to be submitted. MJB and IM were involved in the analysis and interpretation of data, revising the article critically for important intellectual content, and final approval of the version to be submitted. JW, OM and RW were involved in the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content, and final approval of the version to be submitted.
Funding The study was funded by Pfizer Inc.
Disclaimer The research department of MJB has received grant support from Tillotts Pharma and Vifor Pharma (Switzerland). MJB has received honoraria and travel support for consulting or lecturing from Vifor Pharma, Tillotts Pharma and AbbVie. DB, JCC, IM, MDD and RM are employees and stockholders of Pfizer Inc (which funded this study). NB is an employee of Pfizer Inc and stockholder of Pfizer Inc (which funded this study). JW, OM and RW are employed by Adelphi Real World, which received funding from Pfizer Inc in connection with the development of this manuscript.
Competing interests The research department of MJB has received grant support from Tillotts Pharma and Vifor Pharma (Switzerland). MJB has received honoraria and travel support for consulting or lecturing from Vifor Pharma, Tillotts Pharma and AbbVie. DB, JCC, IM, MDD and RM are employees and stockholders of Pfizer Inc (which funded this study). NB is an employee Pfizer Inc and stockholder of Pfizer Inc (which funded this study). JW, OM and RW are employed by Adelphi Real World, which received funding from Pfizer Inc in connection with the development of this manuscript.
Patient consent for publication Not required.
Ethics approval This was a retrospective analysis of data, involving no decisions regarding patient interventions or the omission of interventions, and all patient-level data in the data sources were anonymised. Hence, institutional review board/ethics approval and patient informed consent were not needed. Use of linked CPRD-HES data required Independent Scientific Advisory Committee approval; an abridged version of the protocol was supplied to the committee and approval was granted (Protocol No.: 18_263).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The deidentified patient data accessed and analysed for the purposes of this study are available from the Clinical Practice Research Datalink (email: enquiries@cprd.com) and access to these data are permissible on approval of a written study protocol by the Independent Scientific Advisory Committee.