Drivers of cost after surgical and medical therapy for chronic ulcerative colitis: A nested case-cohort study in Olmsted County, Minnesota

Stefan D. Holubar, Rajesh Pendlimari, Edward Vincent Loftus, Jr, James P. Moriarty, Dirk Larson, Megan O'Byrne, John H. Pemberton, Robert R. Cima

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: We previously reported the costs associated with surgery for chronic ulcerative colitis in the Olmsted County population and found that direct medical costs after surgery were significantly reduced compared with before surgery. However, in that study, costs associated with chronic medical therapy for ulcerative colitis were not assessed in nonsurgical patients. OBJECTIVE: To gain insight into the drivers of costs of treatment for chronic ulcerative colitis, we assessed direct costs after surgical and medical therapy in 120 patients in the Rochester Epidemiology Project database. METHODS: A cohort of 60 patients who recovered from surgery for ulcerative colitis from 1988 to 2006 were 1:1 matched by age, sex, and referent year to medically managed patients. Direct health care costs were estimated from an institutional database, and observed cost differences over a 2-year period were calculated. Statistical significance was assessed by paired t tests and bootstrapping; mean costs are adjusted 2009 constant dollars. RESULTS: Two-year direct health care costs in the surgical and medical cohorts were $10,328 vs $6,586 (p = 0.19). In the surgical cohort, Brooke ileostomy patients were observed to have higher costs than patients with ileal pouches (Δ$8187, p = 0.04), and after ileal pouch, pouchitis was associated with increased costs (Δ$12,763, p < 0.01). In the medical cohort, disease extent (Δ$6059, p = 0.04) but not disease severity was associated with increased costs. LIMITATIONS: This study was limited by the relatively small population size and by its performance in a county with a tertiary referral center. CONCLUSIONS: Before the introduction of biologic therapies for ulcerative colitis, patients were observed to have similar health care costs after surgical and medical therapy. In medically treated patients, disease extent was associated with increased costs, whereas in surgically treated patients, permanent ileostomy and pouchitis were observed to be associated with increased costs.

Original languageEnglish (US)
Pages (from-to)1258-1265
Number of pages8
JournalDiseases of the Colon and Rectum
Volume55
Issue number12
DOIs
StatePublished - Dec 2012

Fingerprint

Ulcerative Colitis
Cohort Studies
Costs and Cost Analysis
Health Care Costs
Pouchitis
Therapeutics
Colonic Pouches
Ileostomy
Databases
Biological Therapy
Population Density
Tertiary Care Centers
Epidemiology

Keywords

  • Chronic ulcerative colitis
  • Direct costs
  • Population-based
  • Surgery ileal pouch-anal anastomosis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Drivers of cost after surgical and medical therapy for chronic ulcerative colitis : A nested case-cohort study in Olmsted County, Minnesota. / Holubar, Stefan D.; Pendlimari, Rajesh; Loftus, Jr, Edward Vincent; Moriarty, James P.; Larson, Dirk; O'Byrne, Megan; Pemberton, John H.; Cima, Robert R.

In: Diseases of the Colon and Rectum, Vol. 55, No. 12, 12.2012, p. 1258-1265.

Research output: Contribution to journalArticle

Holubar, Stefan D. ; Pendlimari, Rajesh ; Loftus, Jr, Edward Vincent ; Moriarty, James P. ; Larson, Dirk ; O'Byrne, Megan ; Pemberton, John H. ; Cima, Robert R. / Drivers of cost after surgical and medical therapy for chronic ulcerative colitis : A nested case-cohort study in Olmsted County, Minnesota. In: Diseases of the Colon and Rectum. 2012 ; Vol. 55, No. 12. pp. 1258-1265.
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T1 - Drivers of cost after surgical and medical therapy for chronic ulcerative colitis

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AU - Holubar, Stefan D.

AU - Pendlimari, Rajesh

AU - Loftus, Jr, Edward Vincent

AU - Moriarty, James P.

AU - Larson, Dirk

AU - O'Byrne, Megan

AU - Pemberton, John H.

AU - Cima, Robert R.

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AB - BACKGROUND: We previously reported the costs associated with surgery for chronic ulcerative colitis in the Olmsted County population and found that direct medical costs after surgery were significantly reduced compared with before surgery. However, in that study, costs associated with chronic medical therapy for ulcerative colitis were not assessed in nonsurgical patients. OBJECTIVE: To gain insight into the drivers of costs of treatment for chronic ulcerative colitis, we assessed direct costs after surgical and medical therapy in 120 patients in the Rochester Epidemiology Project database. METHODS: A cohort of 60 patients who recovered from surgery for ulcerative colitis from 1988 to 2006 were 1:1 matched by age, sex, and referent year to medically managed patients. Direct health care costs were estimated from an institutional database, and observed cost differences over a 2-year period were calculated. Statistical significance was assessed by paired t tests and bootstrapping; mean costs are adjusted 2009 constant dollars. RESULTS: Two-year direct health care costs in the surgical and medical cohorts were $10,328 vs $6,586 (p = 0.19). In the surgical cohort, Brooke ileostomy patients were observed to have higher costs than patients with ileal pouches (Δ$8187, p = 0.04), and after ileal pouch, pouchitis was associated with increased costs (Δ$12,763, p < 0.01). In the medical cohort, disease extent (Δ$6059, p = 0.04) but not disease severity was associated with increased costs. LIMITATIONS: This study was limited by the relatively small population size and by its performance in a county with a tertiary referral center. CONCLUSIONS: Before the introduction of biologic therapies for ulcerative colitis, patients were observed to have similar health care costs after surgical and medical therapy. In medically treated patients, disease extent was associated with increased costs, whereas in surgically treated patients, permanent ileostomy and pouchitis were observed to be associated with increased costs.

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