| アブストラクト | OBJECTIVE: Ulcerative colitis (UC) is a lifelong, relapsing-remitting disease. Patients non-responsive to pharmacological treatment may require a colectomy. We estimated pre-colectomy and post-colectomy healthcare resource utilisation (HCRU) and costs in England. DESIGN/METHOD: A retrospective, longitudinal cohort study indexing adult patients with UC undergoing colectomy (2009-2015), using linked Clinical Practice Research Datalink/Hospital Episode Statistics data, was conducted. HCRU, healthcare costs and pharmacological treatments were evaluated during 12 months prior to and including colectomy (baseline) and 24 months post-colectomy (follow-up; F-U), comparing baseline/F-U, emergency/elective colectomy and subtotal/full colectomy using descriptive statistics and paired/unpaired tests. RESULTS: 249 patients from 26 165 identified were analysed including 145 (58%) elective and 184 (74%) full colectomies. Number/cost of general practitioner consultations increased post-colectomy (p<0.001), and then decreased at 13-24 months (p<0.05). From baseline to F-U, the number of outpatient visits, number/cost of hospitalisations and total direct healthcare costs decreased (all p<0.01). Postoperative HCRU was similar between elective and emergency colectomies, except for the costs of colectomy-related hospitalisations and medication, which were lower in the elective group (p<0.05). Postoperative costs were higher for subtotal versus full colectomies (p<0.001). At 1-12 month F-U, 30%, 19% and 5% of patients received aminosalicylates, steroids and immunosuppressants, respectively. CONCLUSION: HCRU/costs increased for primary care in the first year post-colectomy but decreased for secondary care, and varied according to the colectomy type. Ongoing and potentially unnecessary pharmacological therapy was seen in up to 30% of patients. These findings can inform patients and decision-makers of potential benefits and burdens of colectomy in UC. |
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| ジャーナル名 | BMJ open gastroenterology |
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| Pubmed追加日 | 2020/9/18 |
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| 投稿者 | Brookes, Matthew J; Waller, John; Cappelleri, Joseph C; Modesto, Irene; DiBonaventura, Marco D; Bohm, Natalie; Mokgokong, Ruth; Massey, Olivia; Wood, Robert; Bargo, Danielle |
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| 組織名 | Gastroenterology Department, Royal Wolverhampton NHS Trust, Wolverhampton, UK.;Research Institute in Healthcare Science, Faculty of Science and Engineering,;University of Wolverhampton, Wolverhampton, UK.;Adelphi Real World, Bollington, UK.;Biostatistics, Pfizer Inc, Groton, Connecticut, USA.;Inflammation & Immunology, Pfizer Inc, New York, New York, USA.;Patient Health Impact, Pfizer Inc, New York, New York, USA;Marco.DiBonaventura@pfizer.com.;Pfizer Inc, Tadworth, UK.;Patient Health Impact, Pfizer Inc, New York, New York, USA. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32938582/ |
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