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OP013 Patient-relevant Endpoints in Inflammatory Bowel Diseases - Have Changes Occurred in Germany over the Past Twelve Years?

A. Stallmach*1, U. Dennler2, U. Marschall3, C. Schmidt4

1University Hospital Jena, Clinic for Internal Medicine IV, Jena, Germany, 2Friedrich Schiller University Jena, Geschäftsbereich Medizincontrolling, Jena, Germany, 3BARMER GEK Hauptverwaltung 1100, Kompetenzzentrum Medizin und Versorgungsforschung, Berlin, Germany, 4Clinic for Internal Medicine IV, Jena University Hospital, Jena, Germany

Background

Inflammatory bowel diseases are gaining increasing medical as well as economic significance. Improving medical treatment options can have a positive effect on patient-relevant endpoints such as, for example, the number of hospitalized patients, necessary operations, or the inability to work.

Methods

To understand patient-relevant endpoints in patients with IBD, the 2000 to 2012 data on IBD patients published by the Federal Statistical Office and the 2012 data according to Article 21 of the Hospital Reimbursement Act were assessed. In addition, data records on the medication of IBD patients of a large public health insurance company (Barmer-GEK) were evaluated.

Results

During the period evaluated, the number of inpatients that suffer from IBD (ICD 10 K50, K51) rose from 38,533 to 43,452 (+12.7%). The largest increase was found in patients younger than fifteen years of age. The necessity of surgical intervention (ileocecal or partial colon resection, proctocolectomies) increased during the period under review. The number of people unable to work ("inability-to-work cases" from 2002-2008) developed differently for Crohn's disease (CD) and ulcerative colitis (UC). CD shows an increase of 2.1%, and UC shows a decrease in inability-to-work cases of 9.5%. Entry of persons into the statutory pension insurance system did not significantly decline from 2000 to 2012. The number of potential years of life lost (PYLL) in patients that suffer from IBD also remained constant during the period under review (2000-2002: 2017 PYLL vs. 2011 PYLL (2010-2012)). From 2009 to 2013 the percentage of patients treated with an anti-TNF-antibodies rose (2009: CD: 4.3%; UC: 1.4%; 2013: CD: 8.4%; UC: 3.2%). However, even the 2013 rate is significantly lower than what could be expected from a consistent implementation of the treatment guidelines.

Conclusion

For the patient-relevant endpoints "hospitalizations", "number of necessary operations", "frequency of the inability to work", and "potential years of life lost," a positive development was not observed between 2000 and 2012 in patients that suffer from IBD in Germany. Improvements can only be achieved through structured and overlapping treatment concepts involving all health care providers.