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P194. Is there a difference in quality of life or costs between ulcerative colitis patients with a pouch or an ileostomy?


M. Van der Valk1, M.‑J. Mangen2, G. Dijkstra3, A. van Bodegraven4, H. Fidder1, D. de Jong5, M. Pierik6, C.J. van der Woude7, M. Romberg-Camps8, C. Clemens9, J. Jansen10, P. van de Meeberg11, N. Mahmmod12, C. Ponsioen13, C. Rogge-Wolf14, R. Vermeijden15, P. Siersema1, M. Van Oijen1, B. Oldenburg16

1University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands; 2University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands; 3University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands; 4VU University Medical Center, Gastroenterology, Amsterdam, Netherlands; 5Universitair Medisch Centrum St Radboud, Afd Maag–Darm Leverziekten, Nijmegen, Netherlands; 6Maastricht University Medical Center, Dept of Gastroenterology, Maastricht, Netherlands; 7Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands; 8Orbis Medical Center, Gastroenterology and Hepatology, Sittard, Netherlands; 9Diaconessenhuis, Gastroenterology and Hepatology, Leiden, Netherlands; 10Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, Netherlands; 11Slingeland Hospital, Gastroenterology and Hepatology, Doetinchem, Netherlands; 12Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands; 13Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, Netherlands; 14Reinier de Graaf Gasthuis, Gastroenterology and Hepatology, Delft, Netherlands; 15Meander Medical Center, Gastroenterology and Hepatology, Amersfoort, Netherlands; 16University Medical Centre Utrecht, Department of Gastroenterology, Utrecht, Netherlands



Background: Twenty percent of patients with ulcerative colitis (UC) face colectomy and therefore need to choose between restorative proctocolectomy with a pouch reconstruction or a permanent ileostomy. In order to provide patients and physicians with evidence-based information on both patient-reported outcomes and costs, we compared quality of life and total costs (healthcare costs and productivity costs) in patients with a pouch or ileostomy in a large unselected cohort with IBD patients in the Netherlands.

Methods: We obtained data from the ‘Cost of Inflammatory bowel disease in the Netherlands’ or COIN study, a prospective web-based 3 monthly questionnaire. We included all UC patients with a pouch and ileostomy at 3 months of follow up. The questionnaires contained questions on demographics, health care costs and productivity costs. Health-related quality of life was assessed using the EQ-5D. Costs were calculated by multiplying resource use by the unit costs as determined in the Dutch guidelines for pharmaco-economic analyses for the year 2009 by Oostenbrink et al.

Results: A total of 982 UC patients completed the follow up questionnaire at 3 months, of whom 77 patients (7.8%) had a pouch (57.1% males, mean age 46.8±12.4 years, mean disease duration 14.9±8.8) and 53 patients (5.4%) an ileostomy (54.7% males, mean age 52.7±11.3 years, mean disease duration 16.9±11.5). There was no statistically significant difference in health-related quality of life: mean EQ-5D utility for pouch was 0.85 (SD 0.19), and 0.85 (SD 0.17) for ileostomy. The mean (95% CI) costs per 3 months in patients with a pouch were significantly lower as compared to patients with an ileostomy, €929 (127–1732) versus €1282 (323–2242), respectively (p < 0.01). This was mainly due to higher healthcare costs caused by hospitalizations (2 (2.6%) versus 6 (11.3%)) among UC patients with an ileostomy as compared to UC patients with a pouch (€371 (76–666) versus €66 (27–160), p = 0.02).

Conclusions: We observed no difference in quality of life in patients with a pouch or ileostomy, but patients with a pouch had significantly lower total costs, mainly due to fewer hospitalizations.