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* = Presenting author

P310 Systematic review: The financial burden of surgical complications in patients with ulcerative colitis

J.O. Lindsay1, L. Peyrin-Biroulet*2, A.S. Patel3, A. Bergman4

1The Royal London Hospital, Barts Health NHS Trust Department of Gastroenterology, London, United Kingdom, 2Nancy University Hospital, Université de Lorraine, Inserm U954 and Department of Gastroenterology, Vandouvre-les-Nancy, France, 3Abacus International, Systematic Review, Bicester, United Kingdom, 4Takeda Pharmaceuticals International GmbH, EUCAN (IBD), Glattpark-Opfikon, Switzerland

Background

Patients undergoing colectomy for ulcerative colitis (UC) may experience complications associated with reduced patient quality of life (QoL) that Results in a considerable economic burden to healthcare systems. Appreciation of this burden is important when evaluating the cost-effectiveness of newer interventions for UC versus colectomy. A systematic review was conducted to identify studies reporting resource utilisation, costs of complications and the related QoL burden (presented as health state utility values [HSUVs]) arising from colorectal surgery procedures in patients with UC.

Methods

Embase, MEDLINE and The Cochrane Library were searched for studies (1995-2014) reporting resource use/costs of surgical complications, and HSUVs data in adult patients with UC, undergoing colorectal procedures. Conference proceedings from January 2011-January 2014 were searched manually. Costs were inflated to the 2013 price year using the Consumers Price Index (CPI) and Purchasing power parity (PPP) exchange rates. Quality assessment was conducted alongside extraction of each individual study.

Results

The systematic review identified 15 studies (retrospective observational, n=11). Resource use/costs were reported in 12 studies and three studies reported HSUVs data in patients with UC experiencing postoperative complications. Costs of postoperative complications ranged from $18,650/patient at a six-month follow-up to $35,000/patient over a five-year period. The main cost drivers were reoperations, physician fees, additional inpatient hospital stays and infertility treatment as a result of complications. Pouchitis, pouch failure and small bowel obstruction were the postoperative complications associated with the greatest burden. Across three studies, marked reductions in HSUVs were observed for patients with UC experiencing surgical complications compared with patients with UC in a remission state.

Conclusion

There is a paucity of well-reported studies on resource use/cost, and QoL burden of surgical complications in patients with UC. However, surgical complications represent a substantial burden both in terms of cost and patient QoL. A better understanding of the extent of the burden of surgical complications on healthcare systems and the impact on patient QoL is required to provide accurate cost estimates to inform health technology appraisals for newer UC therapies.