P317 Health care costs associated with standard inflammatory bowel disease care in Australia and opportunities to improve care: a tertiary centre study
B. Jackson*1, R. Ma1, A. Gorelik2, D. Con1, D. Liew2, P. De Cruz1
1Austin Health, Gastroenterology, Melbourne, Australia, 2Melbourne Health, Melbourne, Australia
The chronic nature of IBD together with hospital admissions and surgeries are associated significant cost implications to the healthcare system. Although the high costs of care associated with IBD are recognised, the scale, profile, and determinants of these costs in Australia are unclear. This study aimed to describe costs of illness for IBD patients stratified by disease activity and determine factors associated with increased healthcare costs.
Review of IBD patients managed over a 12-month period at a single tertiary centre in Australia between April 2014 and March 2015. Demographic and clinical data were collected from clinical records and individual resource use was itemised for all attributable costs (including in-patient and outpatient care and extraintestinal manifestation management but excluding primary care costs). Patients were stratified for disease activity.
In total, 288 patients were included in the analysis: 47% were male; mean age was 43 (range 18–86). Further, 140 patients had ulcerative colitis (UC), 145 patients had Crohn’s disease (CD), and 3 patients had IBD unclassified (IBD-U). Of the IBD cohort, 164/288 (57%) were on a 5-aminosalicyclate; 133/288 (46%) were on a thiopurine; 32/288 (11%) were taking methotrexate, and; 55/288 (19%) were treated with an anti-TNF agent. At last review, 72% and 63% of patients were in clinical and endoscopic remission for UC and CD, respectively (according to a 3-item partial Mayo score). Costing data was available for 183/288 (63.5%) of patients from the cohort. The median (IQR) overall cost of secondary (in-patient and outpatient hospital-based) care for the 183 patients over the follow-up period was (AUD) $6 645.4 ($4 168.4–$25 996.5) and was higher in the CD vs UC group ($15 647.7 vs $5 016.5, p < 0.001). The latter difference was predominantly influenced by the difference in the cost of outpatient services for CD patients $9 602.3 ($4 310.7-$29 804.7) vs $4 867.3 ($3 220.0-$7 249.4), p < 0.001). The median (IQR) cost of treating patients with active disease was $3 461 ($1 607-$11 771) and was higher in the CD vs UC group $6 098 ($2 168–$16 471) vs $1 637.5 ($1 401–$3 766.5) (p = 0.006). The median cost of treating patients in remission was $2 090 ($1 552–$12 954) and was non-significantly higher in the CD vs UC group ($7 977 [$1 579–$14 304] vs $1 848 [$1 508–$6 601]).
These data highlight the discrepancy in cost associated with in-patient vs outpatient management of IBD and the increased cost of treating active disease compared with disease in remission, particularly amongst patients with CD. A proactive model of care should therefore be implemented to prevent disease reaching a severity whereby reactive management of active disease and hospitalisation are required.