OP008 The first prospective Australian population-based study of newly diagnosed IBD identifies frequent use of immunomodulators, low surgery rates and high cost from medications and investigations.
O. Niewiadomski*1, C. Studd1, C. Hair2, J. Wilson1, J. Ding1, N. Heerasing2, A. Ting2, K. Ross2, J. Santamaria3, E. Prewett2, P. Dabkowski2, S. Alexander2, D. Dowling2, B. Allen2, B. Popp4, G. Alex5, T. Catto-Smith5, J. McNeill6, W. Connell1, P. Desmond1, S. Bell1
1St Vincent's Hospital, Gastroenterology, Fitzroy, Australia, 2Barwon Health, Gastroenterology, Geelong, Australia, 3St Vincent's Hospital, Intensive Care Unit, Fitzroy, Australia, 4St John of God Pathology, Pathology, Geelong, Australia, 5Royal Children's Hospital, Gastroenterology, Parkville, Australia, 6Monash University, Preventative Medicine and Public Health, Melbourne, Australia
We have previously shown that in Barwon, Victoria (pop. 283,000) the incidence of IBD was 29 & 25 per 100,000 during the periods 2007-8 and 2010-2011, respectively. A prospective registry was established to investigate the natural history of disease and health resource utilization after diagnosis.
Incidence cases of IBD were identified from 2007-2008 and 2010-2013. Details about disease state after diagnosis were prospectively assessed by 6 monthly review of case notes. Severity was assessed by need for hospitalization, surgery and biological use.
252 of 276 incidence cases (91%, 146 Crohn's disease, CD, and 96 Ulcerative colitis, UC) were followed for a median of 18 months (range 1-5 years), including 38 paediatric cases,
“Disease behaviour in CD over 5 years”
. 53 CD patients (36%) required hospitalisation, 41 (77%) in the first year. Ileocolonic disease (HR 3.2, p=0.005) and penetrating disease (HR 2.6, p=0.013) at diagnosis were risk factors for hospitalization. 23 UC patients (24%) were hospitalized, most (70%) in the first 12 months. An elevated CRP at diagnosis predicted hospitalization in UC (HR4.4, p=0.006). Intestinal resection rates in CD were 13% at 1 year, and 23% at 5 years. Risk factors include penetrating or stricturing disease (p<0.001), and ileal involvement (p<0.05) at diagnosis. Colectomy rates in UC were 2% at 1 year, and 13% at 5 years. An elevated CRP predicted need for colectomy (HR 11, p=0.04). IM use was high (57% CD and 19% UC); as were adverse events due to IM (25% in all patients). Biological therapy was used in 13% of CD patients. The cost in the first year in CD was a median $4855/patient (AUS$1571- $57,845); whilst in UC the median was $4608 ($1488- $26,093). Most of the expense was due to medications and investigations
Crohn’s disease (n=146) Ulcerative Colitis (n=96) Phenotype Ileal 46 (32%) Proctitis 31 (32%) Colonic 44 (30%) Left sided 30 (31%) Ileacolonic 56 (38%) + 17 (12%)upper GI + 17 (12%) perianal Pancolitis 35 (36%) Hospitalization 53 (36%) 23 (24%) Exposure to treatment steps 5ASA 77 (53%) 86 (90%) Steroids 99 (68%) 48 (50%) Immunomodulator 83 (57%) 11 (11%) Biologica therapy 18 (12%) 2 (2%) Surgery (resective) 19 (13%) 6 (6%)
“Total expenditure for a) CD and b) UC patients in the first 12 months.”
This first Australian population based study found a high rate of inflammatory disease and immunosuppression in CD and low rate of surgery in both CD and UC. Penetrating, structuring and ileal disease are risk factors for severe disease in CD; high CRP in UC predicts severe disease. Medication use and investigative procedures account for most cost in the first year.