Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2537
Peer-review started: July 21, 2023
First decision: August 15, 2023
Revised: September 27, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: November 27, 2023
Processing time: 128 Days and 23.2 Hours
Patients with Crohn’s disease (CD) are at risk of developing complications such as perianal fistulas. Patients with Crohn’s perianal fistulas (CPF) are affected by fecal incontinence (FI), bleeding, pain, swelling, and purulent perianal discharge, and generally face a higher treatment burden than patients with CD without CPF.
To gain insights into the burden of illness/quality of life in patients with CPF and their treatment preferences and satisfaction.
This cross-sectional observational study was conducted in patients with CD aged 21-90 years via a web-enabled questionnaire in seven countries (April-August 2021). Patients were recruited into three cohorts: Cohort 1 included patients without perianal fistulas; cohort 2 included patients with perianal fistulas without fistula-related surgery; and cohort 3 included patients with perianal fistulas and fistula-related surgery. Validated patient-reported outcome measures were used to assess quality of life. Drivers of treatment preferences were measured using a discrete choice experiment (DCE).
In total, 929 patients were recruited (cohort 1, n = 620; cohort 2, n = 174; cohort 3, n = 135). Short Inflammatory Bowel Disease Questionnaire scores were worse for patients with CPF (cohorts 2 and 3) than for those with CD without CPF (cohort 1): Mean score 3.8 and 3.7 vs 4.1, respectively, (P < 0.001). Similarly, mean Revised FI and FI Quality of Life scores were worse for patients with CPF than for those with CD without CPF. Quality of Life with Anal Fistula scores were similar in patients with CPF with or without CPF-related surgery (cohorts 2 and 3): Mean score 41 and 42, respectively. In the DCE, postoperative discomfort and fistula healing rate were the most important treatment attributes influencing treatment choice: Mean relative importance 35.7 and 24.7, respectively.
The burden of illness in CD is significantly higher for patients with CPF and patients rate lower postoperative discomfort and higher healing rates as the most desirable treatment attributes.
Core Tip: This is the largest known observational study to quantify the burden of illness associated with Crohn’s perianal fistulas (CPF) across multiple countries, utilizing a comprehensive set of outcomes including symptom burden and impacts, and treatment experience, satisfaction, and preferences. This study confirmed that the burden of illness for patients with Crohn’s disease is significantly higher for those with CPF than those without. Patients with CPF rated lower postoperative discomfort and higher healing rates as the most desirable treatment attributes. Assessing patient treatment preferences is key to helping healthcare professionals with clinical management and treatment decisions associated with CPF.