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P559. Comparison of health care utilization and costs among patients with fistulizing Crohn's disease treated with biologics with or without prior seton procedure

D.A. Schwartz1, S.F. Eichner2, J. Lin3, M. Skup2, M. Yang2, P.M. Mulani2, J. Chao2, 1Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, TN, United States, 2Abbott Laboratories, Abbott Park, IL, United States, 3Novosys Health, Flemington, NJ, United States

Background

Biologics (TNF inhibitors) and/or seton drainage are effective options for treating patients with fistulizing Crohn's disease (CD). The aims of this study were to compare health care utilization and costs of patients with fistulizing CD who had the seton procedure vs. those who did not have the seton procedure before treatment with biologics.

Methods

Patients with CD (>18 years) were identified from the MarketScan® research databases by ICD-9 code 555.x between 1/1/2006 and 6/30/2009, and those with fistulizing CD were identified by ICD-9 codes 565.1 and 569.81. Biologics treatment and seton procedures were identified with National Drug Codes or Current Procedural Terminology codes. Patients were grouped into 2 cohorts: seton before biologics treatment (SBB) or no seton before biologics treatment (NSBB). The number of hospitalizations and associated costs, all-cause (AC) and fistula-related (FR), were compared between the SBB and NSBB groups. Multivariate regression was used to control for key patient characteristics and baseline drug use.

Results

Of 385 patients identified, 48 had the seton procedure before treatment with biologics. SBB and NSBB patient groups were similar in age, sex, use of immunosuppressants and steroids in the 6-month baseline period, and illness severity as defined by the Charlson Comorbidity Index; however, the prevalence of diabetes (10.4% vs. 1.8%, P < 0.05), hypertension (20.8% vs. 8.9%, P < 0.05), asthma (6.3% vs. 0.6%, P < 0.05), and the use of antibiotics in the baseline period (87.5% vs. 63.2%, P < 0.05) was greater in the SBB group vs. the NSBB group. The mean numbers of AC and FR hospitalizations were similar during the baseline period for both groups. During the follow-up period, the NSBB group required more hospitalizations than did the SBB group (AC: 0.72±1.12 vs. 0.21±0.62, P < 0.05; FR: 0.33±0.52 vs. 0.08±0.35, P < 0.05). The increased inpatient care was reflected in greater health care costs of the NSBB group vs. the SBB group, respectively (AC: $16,572±33,866 vs. $2618±12,267, P < 0.05; FR: $8571±19,414 vs. $1270±7,512, P < 0.05). Results from a multivariate regression, which adjusted for baseline characteristics and prescription drug use, including antibiotics use, also showed that the NSBB group required more hospitalizations and incurred greater costs than the SBB group.

Conclusion

Patients who had the seton procedure before treatment with biologics used fewer health care resources and incurred lower health care costs compared with those who did not.