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P218. Evaluation of the burden of the disease in patients with Crohn's disease and complex perianal fistula

M. Chaparro1, P. Burgueño1, I. Vera2, F. Bermejo3, I. Martín-Jiménez4, C. Yela5, P. López6, M. Martín7, C. Taxonera8, B. Botella9, R. Pajares10, A. Ponferrada11, M. Calvo2, A. Algaba3, L. Pérez4, B. Casis5, J. Maté1, J.P. Gisbert1

1Hospital de la Princesa, Madrid, Spain; 2Hospital Puerta de Hierro, Madrid, Spain; 3Hospital de Fuenlabrada, Madrid, Spain; 4Hospital Gregorio Marañón, Madrid, Spain; 5Hospital Doce de Octubre, Madrid, Spain; 6Hospital de Alcorcón, Madrid, Spain; 7Hospital de la Paz, Madrid, Spain; 8Hospital Clinico San Carlos, Madrid, Spain; 9Hospital Infanta Cristina, Madrid, Spain; 10Hospital Infanta Sofía, Madrid, Spain; 11Hospital Infanta Leonor, Madrid, Spain

Introduction: There is no information available regarding the cost of treatment of patients with Crohn's disease (CD) and complex perianal fistula.

Aim: To estimate the burden of the disease of patients with CD and complex perianal fistula.

Methods: A retrospective, observational, multicentre study was carried out on a cohort of CD patients with complex perianal fistula that had been active at any time since January 2005 to January 2010. Only the last 5 years were considered in the study in order to obtain a stronger homogeneity of the data. Treatment received by each patient, medical visits and associated testing were recorded. Costs of medical visits, examinations and therapeutic interventions were estimated according to those published by the Colegio Oficial de Médicos (Official Medical College). Indirect costs were not evaluated.

Results: Ninety-seven patients with CD and complex perianal fistula were included. The mean age was 41 and 56% were male. 74% of patients had received antibiotic treatment, 80% immunosuppressants, 75% biologics and 74% had undergone surgical intervention. The mean number of visits (SD) to a gastroenterologist was 12 (10), to a general surgeon 4.1 (4.4) and to a primary care provider 2.1 (6.9). The mean number of visits to the emergency department was 0.84 (1.2). Sixty-four percent of patients were hospitalized during the study time period, with a median of 1.2 hospitalizations of 9.9 days of length per patient. The most frequent laboratory test performed was blood analysis, with an average of 14 (15) tests per patient (3.4 tests per patient per year). Eighty percent of patients had at least one endoscopic examination during the study time period, 68% had at least one pelvic MRI scan, 46% at least one anal examination under anesthesia and 31% of patients at least one endoscopic ultrasound. The median costs associated with pharmaceutical treatment was €18,558, hospitalization €1,351, visits to physicians €1,485, diagnostic and therapeutic testing €731 and additional laboratory testing €122. The median cost per patient in the study time period was €26,342 (range of €1,789-€210,244), with a median cost of €6,272 per patient-year.

Conclusions: The direct costs associated with the diagnosis and treatment of complex perianal fistula in patients with CD is very high. Pharmaceutical treatment accounts for the highest proportion of these costs.