Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3860-3868
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3860
Cost-effectiveness of Crohn’s disease post-operative care
Emily K Wright, Michael A Kamm, Peter Dr Cruz, Amy L Hamilton, Kathryn J Ritchie, Sally J Bell, Steven J Brown, William R Connell, Paul V Desmond, Danny Liew
Emily K Wright, Michael A Kamm, Peter Dr Cruz, Amy L Hamilton, Kathryn J Ritchie, Sally J Bell, Steven J Brown, William R Connell, Paul V Desmond, Department of Gastroenterology, St Vincent’s Hospital, University of Melbourne, Fitzroy VIC 3065, Melbourne, Australia
Michael A Kamm, Imperial College, London SW7 2AZ, United Kingdom
Danny Liew, Melbourne EpiCentre, University of Melbourne and Melbourne Health, Parkville VIC 3010, Melbourne, Australia
Author contributions: Wright EK, Kamm MA and DeCruz P study concept and design; acquisition of data, analysis, data interpretation; drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis; Hamilton AL acquisition of data, analysis and interpretation of data, drafting of the manuscript; Ritchie K acquisition and monitoring of data; Liew D analysis and interpretation of data, drafting of the manuscript; statistical analysis; Bell SJ, Brown SJ, Connell WR and Desmond PV acquisition of data and critical review of manuscript.
Institutional review board statement: This study is a sub study of the Post-Operative Crohn’s Endoscopic Recurrence (POCER) study which was approved by the Human Research Ethics Committee of St Vincent’s Hospital Research Governance Unit (HREC-A 077/09).
Clinical trial registration statement: This study is a sub study of the Post-Operative Endoscopic Recurrence (POCER) study which was registered and approved at Clinicaltrial.gov. Number NCT00989560.
Informed consent statement: All study participants provided informed written consent prior to study enrolment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael A Kamm, Professor, Department of Gastroenterology, St Vincent’s Hospital, University of Melbourne, Victoria Parade, Fitzroy VIC 3065, Melbourne, Australia. mkamm@unimelb.edu.au
Telephone: + 61-3-94175064 Fax: +61-3-94162485
Received: November 15, 2015
Peer-review started: November 16, 2015
First decision: December 11, 2015
Revised: December 22, 2015
Accepted: January 30, 2016
Article in press: January 31, 2016
Published online: April 14, 2016
Processing time: 134 Days and 21.8 Hours
Abstract

AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.

METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.

RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.

CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.

Keywords: Crohn’s disease; Post-operative; Health economics; Health care cost; Biologics

Core tip: The health care costs of a proactive disease-prevention post-operative Crohn’s disease strategy are substantial. Much of this cost relates to drug therapy (biologics). Active care involving endoscopic monitoring for disease recurrence, costs more than symptom-based monitoring. The occurrence of endoscopic recurrence increases costs significantly, related largely to drug therapy. Faecal calprotectin to monitor for disease recurrence can substantially decrease post-operative costs.