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P367 Lower quality of life, more active disease and increased healthcare costs due to non-adherence in inflammatory bowel disease

M. Severs*1, M.-J. Mangen2, H. H. Fidder1, M. E. van der Valk1, M. van der Have1, A. A. van Bodegraven3, 4, C. H. M. Clemens5, G. Dijkstra6, J. M. Jansen7, D. J. de Jong8, N. Mahmmod9, P. C. van de Meeberg10, A. E. van der Meulen- de Jong11, M. Pierik12, C. Y. Ponsioen13, M. J. L. Romberg- Camps3, P. D. Siersema1, J. R. Vermeijden14, J. van der Woude15, P. N. Zuithoff16, B. Oldenburg1

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

Background

Long-term effects of non-adherence to medical therapy in inflammatory bowel diseases (IBD) are largely unknown. We aimed to investigate the impact of medication adherence on the disease course, healthcare costs and health-related quality of life (HrQoL) over time amongst adult patients with IBD.

Methods

A large cohort of patients with Crohn’s disease (CD) and ulcerative colitis (UC) was prospectively followed for 2.5 years. Data were collected on flares, IBD-specific healthcare utilisation, QoL (using the IBDQ), and medication adherence, using 3-monthly questionnaires. Healthcare costs were calculated by multiplying consumption of healthcare with corresponding unit prices. Adherence was self-assessed by a visual analogue scale (VAS) with rates ranging from 0 to 100%; and were categorised into low (< 50%), moderate (50%–80%), and high adherence (≥ 80%). We used a generalised linear mixed model for continuous and dichotomous outcomes, incorporating a correction for time-dependent measurements (ie, previous disease severity and disease duration), age, smoking, and gender. Moreover, we compared IBDQ scores over the total follow-up period between patients with a high adherence during the majority (≥ 67%) of follow-up measurements, and patients with a low adherence during the majority of follow-up measurements.

Results

In total, 2 612 patients (1 558 CD and 1054 UC) were evaluated, of whom 77.6% used IBD-related medication. Further, 3% was low adherent; 13% was moderate adherent; and 84% was high adherent. In UC, medium- and low-adherent patients were at higher risk for developing a flare after 3 months (odds ratio (OR) 1.32 and 1.57, respectively, p = 0.02). Low-adherent CD patients during the majority of follow-up, had lower median IBDQ scores than high-adherent patients (144.7 vs 178.7, p = 0.01). Low adherence was also associated with a subsequent 3-point decrease in IBDQ scores after 3 and 6 months (p = 0.02 and p = 0.06, respectively). IBDQ scores were not affected by medication adherence in UC patients. Although 3-monthly healthcare costs of high-adherent patients initially showed a (non-significant) increase compared with low-adherent patients, after 6 months of follow-up, the 3-monthly costs of low-adherent patients increased by €111 in UC patients and €1,110 in CD patients, compared with their high-adherent counterparts (p = 0.58 and p = 0.03, respectively).

Conclusion

Long-term effects of low adherence in IBD include a higher risk for flares in UC, a lower disease-related HrQoL in CD, and a substantial increase in healthcare costs in CD patients. Improving adherence to maintenance therapy in clinical practice may result in a less severe course of disease.