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P515 Costs associated with the management of refractory complex perianal fistulas in patients with Crohn's disease

M. D. Martín-Arranz*1, I. Pascual Migueláñez1, J. L. Marijuán1

1Hospital Universitario La Paz, Servicio de Ap. Digestivo, Madrid, Spain


Management of complex perianal fistulas (CPFs) in Crohn's Disease (CD) continues to be a controversial issue nowadays. Due to the complexity of this complication, the multiple recurrences and the absence of high-quality evidence and the limited efficacy of the available treatments there many unsolved questions and the treatment involves both medical and surgical approaches. This study aims to quantify the economic impact associated with current treatment alternatives for CPFs in CD.


An exhaustive literature review has been performed together with the analysis of the real-world clinical practice in University Hospital La Paz, Madrid, Spain. After analysing the healthcare process, an economic model has been elaborated to estimate the costs associated to the current approach of CPFs in CD. The model only contemplates a maximum of one intervention (medical or surgical) per year. The costs of recurrences, the main side effects and work productivity impact of the different therapeutic alternatives have also been calculated.


The estimated direct annual cost of CPF treatment in CD in Spain, extrapolated from data from one university hospital is at least €21253374 (€15241/patient) for an estimated population of 1394 patients. The estimated cost corresponding to anti-TNF drugs represents 79.80% (€16961154, €12163/patient), to surgeries 6.37% (€1354551, €971/patient), to recurrences 8.37% (€1779658, €830/patient) and to secondary effects 5.45% (€1158011, €830/patient). The average cost of surgeries in patients who are treated surgically (40% of the total) is estimated at €2427.51/patient. With regard to indirect costs, the impact on work productivity due to absences and sick leave is at least €182011 per year. Work absences are estimated to range between 10 and 30 days in almost 70% of patients, at an annual cost of €786217.


The present study indicates that almost 80% of the total annual direct costs of the current treatment of CPFs in CD are due to anti-TNF drugs. This estimated annual cost, being a chronic complication, would often spread over several years, so that total costs associated with the definitive remission of CPFs would be significantly higher than the one estimated here. It would be desirable to count with new treatments for the management of these patients that could contribute to decrease the need for both surgery and use of anti-TNFs, reducing the costs associated with the treatment of this type of patients.