TY - JOUR

T1 - Effect of phenotype on health care costs in Crohn's disease

T2 - A European study using the Montreal classification

AU - Odes, Selwyn

AU - Vardi, Hillel

AU - Friger, Michael

AU - Wolters, Frank

AU - Hoie, Ole

AU - Moum, Bjørn

AU - Bernklev, Tomm

AU - Yona, Hagit

AU - Russel, Maurice

AU - Munkholm, Pia

AU - Langholz, Ebbe

AU - Riis, Lene

AU - Politi, Patrizia

AU - Bondini, Paolo

AU - Tsianos, Epameinondas

AU - Katsanos, Kostas

AU - Clofent, Juan

AU - Vermeire, Severine

AU - Freitas, João

AU - Mouzas, Iannis

AU - Limonard, Charles

AU - O'Morain, Colm

AU - Monteiro, Estela

AU - Fornaciari, Giovanni

AU - Vatn, Morten

AU - Stockbrugger, Reinhold

AU - European Collaborative Study Group on Inflammatory Bowel Disease

PY - 2007/12

Y1 - 2007/12

N2 - BACKGROUND: Crohn's disease (CD) is a chronic inflammation of the gastrointestinal tract associated with life-long high health care costs. We aimed to determine the effect of disease phenotype on cost.METHODS: Clinical and economic data of a community-based CD cohort with 10-year follow-up were analyzed retrospectively in relation to Montreal classification phenotypes.RESULTS: In 418 patients, mean total costs of health care for the behavior phenotypes were: nonstricturing-nonpenetrating 1690, stricturing 2081, penetrating 3133 and penetrating-with-perianal-fistula 3356 €/patient-phenotype-year (P<0.001), and mean costs of surgical hospitalization 215, 751, 1293 and 1275 €/patient-phenotype-year respectively (P<0.001). Penetrating-with-perianal-fistula patients incurred significantly greater expenses than penetrating patients for total care, diagnosis and drugs, but not surgical hospitalization. Total costs were similar in the location phenotypes: ileum 1893, colon 1748, ileo-colonic 2010 and upper gastrointestinal tract 1758 €/patient-phenotype-year, but surgical hospitalization costs differed significantly, 558, 209, 492 and 542 €/patient-phenotype-year respectively (P<0.001). By multivariate analysis, the behavior phenotype significantly impacted total, medical and surgical hospitalization costs, whereas the location phenotype affected only surgical costs. Younger age at diagnosis predicted greater surgical expenses.CONCLUSIONS: Behavior is the dominant phenotype driving health care cost. Use of the Montreal classification permits detection of cost differences caused by perianal fistula.

AB - BACKGROUND: Crohn's disease (CD) is a chronic inflammation of the gastrointestinal tract associated with life-long high health care costs. We aimed to determine the effect of disease phenotype on cost.METHODS: Clinical and economic data of a community-based CD cohort with 10-year follow-up were analyzed retrospectively in relation to Montreal classification phenotypes.RESULTS: In 418 patients, mean total costs of health care for the behavior phenotypes were: nonstricturing-nonpenetrating 1690, stricturing 2081, penetrating 3133 and penetrating-with-perianal-fistula 3356 €/patient-phenotype-year (P<0.001), and mean costs of surgical hospitalization 215, 751, 1293 and 1275 €/patient-phenotype-year respectively (P<0.001). Penetrating-with-perianal-fistula patients incurred significantly greater expenses than penetrating patients for total care, diagnosis and drugs, but not surgical hospitalization. Total costs were similar in the location phenotypes: ileum 1893, colon 1748, ileo-colonic 2010 and upper gastrointestinal tract 1758 €/patient-phenotype-year, but surgical hospitalization costs differed significantly, 558, 209, 492 and 542 €/patient-phenotype-year respectively (P<0.001). By multivariate analysis, the behavior phenotype significantly impacted total, medical and surgical hospitalization costs, whereas the location phenotype affected only surgical costs. Younger age at diagnosis predicted greater surgical expenses.CONCLUSIONS: Behavior is the dominant phenotype driving health care cost. Use of the Montreal classification permits detection of cost differences caused by perianal fistula.

U2 - 10.1016/j.crohns.2007.08.004

DO - 10.1016/j.crohns.2007.08.004

M3 - Journal article

C2 - 21172190

VL - 1

SP - 87

EP - 96

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

SN - 1873-9946

IS - 2

ER -