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* = Presenting author

P640 Smoking is associated with higher healthcare costs in IBD patients, primarily due to more frequent anti-TNFalpha use

M. Severs*1, M.E. van der Valk1, M.-J. Mangen2, M. van der Have1, G. Dijkstra3, A.A. van Bodegraven4, 5, H.H. Fidder1, D.J. de Jong6, M. Pierik7, J. van der Woude8, M.J.L. Romberg- Camps4, C.H.M. Clemens9, J.M. Jansen10, P.C. van de Meeberg11, N. Mahmmod12, A.E. van der Meulen- de Jong13, C.Y. Ponsioen14, C.J. Bolwerk15, J.R. Vermeijden16, P.D. Siersema1, M. Leenders1, B. Oldenburg1

1University Medical Centre Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands, 2University Medical Centre Utrecht, Julius center for health sciences and primary care, Utrecht, Netherlands, 3University Medical Centre Groningen, Gastroenterology and Hepatology, Groningen, Netherlands, 4ORBIS medical center, Gastroenterology and Hepatology, Sittard, Netherlands, 5VU medical center, Gastroenterology and Hepatology, Amsterdam, Netherlands, 6University Medical Center st. Radboud, Gastroenterology and Hepatology, Nijmegen, Netherlands, 7University Medical Center Maastricht, Gastroenterology and Hepatology, Maastricht, Netherlands, 8Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 9Diaconessenhuis, Gastroenterology and Hepatology, Leiden, Netherlands, 10Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, Netherlands, 11Slingeland Hospital, Gastroenterology and Hepatology, Doetinchem, Netherlands, 12Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands, 13Leiden University Medical Centre, Gastroenterology and Hepatology, Leiden, Netherlands, 14Academic Medical Centre Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands, 15Reinier de Graaf Groep, Gastroenterology and Hepatology, Delft, Netherlands, 16Meander Medical Centre, Gastroenterology and Hepatology, Amersfoort, Netherlands

Background

Smoking effects the disease course of inflammatory bowel disease (IBD). We aimed to study the impact of smoking on IBD-specific healthcare costs, disease activity and quality of life among adults with IBD.

Methods

A large cohort of IBD patients were prospectively followed for two years by three-monthly questionnaires (the COIN- study). Smoking status of patients was obtained at baseline while cost items, disease activity and quality of life were assessed during follow-up. Healthcare costs, disease activity and quality of life were compared between smokers and non-smokers. Differences between Crohn's disease (CD) and ulcerative colitis (UC) were identified. In addition, risk factors for high healthcare costs were examined using logistic regression analyses, adjusted for potential confounders.

Results

In total, 3,030 patients (1,558 CD, 1,054 UC and 418 IBD-unspecified) were enrolled, of whom 486 patients (16%) were current smokers. Smoking CD patients more frequently had active disease or fistulas than non-smoking CD patients. Also, smoking CD patients and those who had stopped smoking after the diagnosis of CD had a higher number of flares in the past and in addition, had undergone abdominal surgery more frequently. In contrast, smoking UC patients appeared to have a lower number of flares in the past. After one year of follow up, smoking CD patients had significant higher disease activity scores (Short Crohn's Disease Activity Index: median 170 vs. 149, p <0.001), whereas in UC, disease activity scores did not differ between smokers and non- smokers (Modified TrueLove & Witts Index: median 4 vs. 4, p =0.11). Mean total direct health care costs after one year of follow-up were 45% higher in the smoking IBD population as compared to the non-smoking population (Euro: 6,020; 95% confidence interval (CI) 4,607 - 7,434 vs. 4,166; 95% CI 3,715 - 4,617, p <0.001), which was mainly explained by a higher percentage of TNFalpha inhibitor users (19.3% vs. 13.0%, p =0.001). When analysed separately, smoking CD and UC patients were still found to incur higher costs, although statistical significance was lost (CD: Euro 7,845 vs. 6,472, p =0.16; UC: 3,101 vs. 2,315, p =0.31). Multivariate analysis revealed smoking as an independent factor for high healthcare costs in IBD (adj. odds ratio 1.75; 95% CI 1.09 - 2.81). Moreover, the quality of life proved to be significantly worse in the smoking population, which applied to both CD as well as UC (median IBD- questionnaire: 170 vs. 184, p <0.001).

Conclusion

Mean healthcare costs are 45% higher in smoking IBD patients, primarily due to anti-TNFalpha use. The quality of life is decreased in both smoking CD as well as UC patients.