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P265. Cost-effectiveness of surgery and infliximab for refractory ulcerative colitis: a single centre study using patient-level data

N. Arebi1, D. Karapiperis1, S. Tripoli1, N. Poonja1, 1St Mark's Hospital, London, United Kingdom

Background

A third of patients with Ulcerative Colitis (UC), fail standard medical therapy including thiopurines. Surgery or Infliximab (IFX) are considered potential options. There are no head to head studies of surgery compared to IFX. Instead, decision model analyses have been used to define the cost-effectiveness of surgery compared with IFX. There are no comparative studies with patient-level data. The aim of the study was to evaluate the cost effectiveness of surgery compared with Infliximab using patient-level data, considering all costs relevant to a clinical setting.

Methods

Retrospective analysis of patients with refractory UC undergoing surgery or IFX between Apr 2010 and Mar 2011 was undertaken. Clinical outcomes were based on last recorded clinical state, quality of life (EQ5D) and length of hospital stay (days). Resource cost categories included hospital length of stay and number of admissions, interventions (surgery or Infliximab), stoma and diagnostic tests: average costs were used to calculate ICER. Clinical effectiveness was assessed as binary measure: good or poor clinical outcome or per days of hospitalisation. Mann–Whitney U test was used to measure effect of complications on cost.

Results

A total of 30 patients underwent surgery compared to 8 receiving IFX. The median age for the surgical and IFX intervention groups was 38.5 years (range 18–75) and 38 years (range 27–61). Patient demographics were similar except for median follow-up was longer for surgery. The mean cost for surgical group was £22,920 compared with £12,723 IFX. Surgery group showed an ICER of £784 per good surgical outcome and £784 per day in hospital. Comparison of hospital days and admissions is shown in Table 1.

Eleven of the 30 surgical patients were reported to have ≥1 complication. The costs without complications (n = 19) and costs with complications (n = 11) were ranked. Surgical costs were significantly related to complications (P = 0.001) with added hospital days and imaging tests

Table 1. Clinical effectiveness of Infliximab compared to surgery
 InfliximabSurgery
Mean hospital stay (days)15.828.8
Mean no. of admissions1.72.5
Mean no. of interventions5.32.6
Patients with good outcome (%)6350

Conclusion

Very few patients had access to IFX. This was due to reimbursement restriction of IFX for UC in the UK. Short term costs of surgery are higher than IFX and related to complications. Further research to capture cost over longer period of time and additional settings may identify strategies to reduce costs.