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P443 National treatment strategy in inflammatory bowel diseases in Hungary: results from the National Health Insurance Fund Prescription Database

Z. Kurti*1, L. Gonczi1, P. A. Golovics1, B. Lovasz1, P. Fadgyas-Freyler2, J. Gimesi-Orszagh2, G. B. Korponai2, Z. Vegh1, P. Lakatos1

1Semmelweis University, First Department of Medicine, Budapest, Hungary, 2National Health Insurance Fund (OEP), Strategic Analysis Department, Budapest, Hungary

Background

The therapeutic strategy of IBD has significantly changed in the last decade. Data on national health treatment strategy and drug exposures from population-based, nationwide cohorts are still lacking. Aim: to report the treatment strategy in patients with IBD in 2013 in the patients identified through the National Health Fund database in Hungary, overall, by disease, and in different age groups.

Methods

Patients were identified according to international classification codes for ulcerative colitis (UC) and Crohn’s disease (CD) in the in-patient care, day surgery, non-primary outpatient care, and drug prescription databases (2011–2013) of the National Health Insurance Fund (OEP), the only nationwide, state-owned health insurance provider in Hungary. Treatment steps were evaluated according to disease type and age groups (group A 0–19 years; group B 20–59 years; and group C > 60 years).

Results

In total, 55 039 IBD patients were identified, and amongst them, 13 227 CD and 18007 UC patients were actively treated (defined as 2 or more IBD-related visits, plus at least 1 dispensed prescription of IBD-related drugs preoperative in 2011–2013). In CD patients, 5-ASA use was high in every age groups; immunosuppressives (IS) and biological therapy use was highest in paediatric CD (IS 44% in group A; biological 15% in group A, p < 0.01). In both CD and UC, about one-third of the patients received steroid. In UC, IS and biological therapy use was infrequent in every age group. The use of combined immunosuppression was also infrequent in both CD and UC, except for paediatric CD (24% IS and biologicals).

Table 1 Drug prescription strategy in IBD according to disease type and age groups

Age groupsDiagnosisTotal no. of patients5-ASASteroidsIS therapyBiological therapy
0–19 yearsUC1 064 (2%)706 (66%)389 (36%)230 (21%)42 (4%)
0–19 yearsCD1 686 (3%)1 155 (68%)688 (41%)743 (44%)258 (15%)
0–19 yearsIBDU116 (0.2%)100 (86%)48 (41%)48 (41%)12 (1%)
20–59 yearsUC21 456 (39%)15 663 (73%)6 673 (31%)2 289 (11%)622 (3%)
20–59 yearsCD15 053 (27%)10 706 (71%)5 055 (33%)5 039 (33%)1 387 (9%)
20–59 yearsIBDU1 035 (2%)832 (80%)416 (40%)297 (29%)93 (9%)
60+ yearsUC11 240 (20%)8 130 (72%)3 111 (28%)419 (3%)79 (1%)
60+ yearsCD3 172 (6%)2 210 (69%)983 (31%)441 (14%)49 (2%)
60+ yearsIBDU217 (0.4%)174 (80%)100 (46%)43 (20%)< 5 (< 0.5%)

Conclusion

The treatment strategy in IBD in Hungary, according to the National Health Fund Prescription Database, was characterised by high overall 5ASA use and moderate steroid exposure. The use of IS and biologicals was age dependent in CD and infrequent in UC