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P387. Reduced length of hospitalisation and treatment costs with infliximab versus ciclosporin in patients with severe ulcerative colitis

M. Lowenberg1, N. Duijvis1, C. Ponsioen1, W. Bemelman2, G. van den Brink1, P. Fockens1, G. D'Haens1, 1AMC, Gastroenterology, Amsterdam, Netherlands, 2AMC, Surgery, Amsterdam, Netherlands

Background

Efficacy and safety of treatment with ciclosporin or infliximab are comparable in patients with severe ulcerative colitis (UC) (Laharie D et al, Lancet, 2012). Reduction of duration of hospital stay has important impact on treatment costs.

Aim: To analyse duration of hospital stay and costs in patients admitted for severe UC receiving treatment with ciclosporin or infliximab.

Methods

We carried out a retrospective analysis of patients with steroid-refractory UC treated with intravenous ciclosporin or infliximab. Adult and paediatric patients were included who were naïve to either therapy and admitted between March 2004 and August 2012 at a single tertiary referral centre. Information was retrieved from patient records. Length of hospital stay from initiation of rescue therapy to time of discharge was analyzed. Hospital costs for both treatment groups were analyzed.

Results

A total of 42 patients (mean age 35 years; 43% female) were included in the analysis, with 26 (range 17–56 years) in the ciclosporin and 16 (range 16–69 years) in the infliximab group. Patient characteristic showed no statistically significant difference between the two groups: median duration of disease 7 versus 6 years, smoking 23% vs. 31%, thiopurine use 46% vs. 69% and proportion of patients with pancolitis 90% vs. 69% in the ciclosporin and infliximab group, respectively. The median length of hospital stay after initiation of therapy was 10.3 days in ciclosporin treated patients (range 6–19 days) vs. 4.5 days in the infliximab group (range 2–8 days) (P < 0.0001). Hospital costs without drug costs were significantly greater for ciclosporin than for infliximab treated patients [average costs per patient: 5750 and 2588 euro in the ciclosporin and infliximab group, respectively (P < 0.0001)]. Total treatment costs per patient (including drug costs) averaged to 6041 vs. 4853 euro for ciclosporin and infliximab treated patients, respectively. There was no significant difference in colectomy rates in the years following rescue therapy between the two groups (42.3% and 43.8% for ciclosporine and infliximab, respectively).

Conclusion

Length of hospital stay and hospital costs have been reduced significantly since the introduction of infliximab as rescue therapy for severe UC instead of ciclosporin.