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P623 Therapeutic preferences and outcomes in newly diagnosed patient with inflammatory bowel diseases in the biological era in Hungary. A nationwide study based on the National Health Insurance Fund database

Gonczi L.*1, Vegh Z.1, Kurti Z.1, Lovasz B.D.1, Golovics P.A.1, Fadgyas-Freyler P.2, Gimesi-Orszagh J.2, Gecse K.B.1, Lakatos P.L.1

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

Background

Accelerated treatment strategy, including tight disease control and early aggressive therapy with immunomodulators (IM) and biological agents has become increasingly common in IBD. The aim of the present study was to estimate the early treatment strategy and outcomes in newly diagnosed IBD patients between 2004–2009 and 2009–2015 in Hungary in the administrative database of the National Health Insurance Fund (OEP).

Methods

We used the nationwide administrative database of the National Health Insurance Fund (OEP), the only nationwide state-owned health insurance provider in Hungary. Patients were identified through previously reported algorhythms using the ICD-10 codes for Crohn's disease (CD) in the out-, inpatient (medical, surgical) non-primary care records and drug prescription databases between 2004–2015. Patients were stratified according to the year of diagnosis and maximum treatment step during the first 3-years after the diagnosis.

Results

A total of 6173 newly diagnosed CD patients with physician-diagnosed IBD were found in this period. Rate of maximum treatment step did not differ before and after 2009 (5-ASA: 12% vs, 14%, Steroid 31% vs. 31%, IM 44% vs. 44%, biological 13% vs. 12%). Probability of hospitalizations in the first 3-years after the diagnosis according to the maximal treatment step was different before and after 2009 (at 12-months: anti-TNF: 63% vs. 57% (p=0.03) IS: 56% vs. 50% (p=0.002), steroid: 32% vs. 58% (p<0.001)), respectively. In contrast, surgery rates were not significantly different in patients diagnosed before and after 2009 according to the maximum treatment step (at 12-months: anti-TNF 9% vs. 13%, IS: 56% vs 49%, steroid 36% vs. 34%, 5-ASA 27% vs. 26%).

Conclusion

The rate of maximal treatment steps and surgery rates did not differ in patients diagnosed before and after 2009. Hospitalization rates during the first 3-years after the diagnosis decreased in all – but the steroid- treatment groups, suggesting a change in the patient management.