Long-term direct costs before and after proctocolectomy for ulcerative colitis: A population-based study in olmsted county, Minnesota

Stefan D. Holubar, Kirsten Hall Long, Edward Vincent Loftus, Jr, Bruce G. Wolff, John H. Pemberton, Robert R. Cima

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: This study was designed to test the hypothesis that patients undergoing definitive surgery for chronic ulcerative colitis have reduced direct medical costs after, as compared with before, total proctocolectomy. METHODS: A population-based cohort of patients who underwent proctocolectomy for ulcerative colitis from 1988 to 2007 was identified using the Rochester Epidemiology Project. Total direct healthcare costs were estimated from an administrative database. The primary outcome was the observed cost difference between the two-year period before surgery and the two-year period after a surgery/recovery period (surgery + 180 days). Statistical significance was assessed using paired t-tests and bootstrapping methods. Demographic data were presented as median (interquartile range) or frequency (proportion). Mean costs are reported in 2007 constant dollars. RESULTS: Sixty patients were Olmsted County, Minnesota, residents at the time of surgery and for the entire period of observation. Overall 40 patients (66%) were men, median age was 42 (range, 31-52) years, and duration of median colitis was four (range, 1-11) years. Operations included ileal pouch-anal anastomosis (n = 45, mean cost of surgery/recovery period = $50,530) and total proctocolectomy with Brooke ileostomy (n = 15, mean cost of surgery/recovery period = $39,309). In the pouch subgroup, direct medical costs on average were reduced by $9,296 (P < 0.001, bootstrapped 95% confidence interval: $324-$15,628) during the two years after recovery. In the Brooke ileostomy subgroup, direct medical costs on average were reduced by $12,529 (P < 0.001, bootstrapped 95% confidence interval: $6,467- $18,688) in the two years after recovery. CONCLUSION: Surgery for chronic ulcerative colitis resulted in reduced direct costs in the two years after surgical recovery. These observations suggest that surgical intervention for ulcerative colitis is associated with long-term economic benefit.

Original languageEnglish (US)
Pages (from-to)1815-1823
Number of pages9
JournalDiseases of the Colon and Rectum
Volume52
Issue number11
DOIs
StatePublished - Nov 2009

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Ulcerative Colitis
Costs and Cost Analysis
Population
Ileostomy
Confidence Intervals
Colonic Pouches
Colitis
Ambulatory Surgical Procedures
Health Care Costs
Epidemiology
Economics
Observation
Demography
Databases

Keywords

  • Cost analysis
  • Epidemiology
  • Ileal pouch-anal anastomosis
  • Population-based
  • Proctocolectomy
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Long-term direct costs before and after proctocolectomy for ulcerative colitis : A population-based study in olmsted county, Minnesota. / Holubar, Stefan D.; Long, Kirsten Hall; Loftus, Jr, Edward Vincent; Wolff, Bruce G.; Pemberton, John H.; Cima, Robert R.

In: Diseases of the Colon and Rectum, Vol. 52, No. 11, 11.2009, p. 1815-1823.

Research output: Contribution to journalArticle

Holubar, Stefan D. ; Long, Kirsten Hall ; Loftus, Jr, Edward Vincent ; Wolff, Bruce G. ; Pemberton, John H. ; Cima, Robert R. / Long-term direct costs before and after proctocolectomy for ulcerative colitis : A population-based study in olmsted county, Minnesota. In: Diseases of the Colon and Rectum. 2009 ; Vol. 52, No. 11. pp. 1815-1823.
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abstract = "Purpose: This study was designed to test the hypothesis that patients undergoing definitive surgery for chronic ulcerative colitis have reduced direct medical costs after, as compared with before, total proctocolectomy. METHODS: A population-based cohort of patients who underwent proctocolectomy for ulcerative colitis from 1988 to 2007 was identified using the Rochester Epidemiology Project. Total direct healthcare costs were estimated from an administrative database. The primary outcome was the observed cost difference between the two-year period before surgery and the two-year period after a surgery/recovery period (surgery + 180 days). Statistical significance was assessed using paired t-tests and bootstrapping methods. Demographic data were presented as median (interquartile range) or frequency (proportion). Mean costs are reported in 2007 constant dollars. RESULTS: Sixty patients were Olmsted County, Minnesota, residents at the time of surgery and for the entire period of observation. Overall 40 patients (66{\%}) were men, median age was 42 (range, 31-52) years, and duration of median colitis was four (range, 1-11) years. Operations included ileal pouch-anal anastomosis (n = 45, mean cost of surgery/recovery period = $50,530) and total proctocolectomy with Brooke ileostomy (n = 15, mean cost of surgery/recovery period = $39,309). In the pouch subgroup, direct medical costs on average were reduced by $9,296 (P < 0.001, bootstrapped 95{\%} confidence interval: $324-$15,628) during the two years after recovery. In the Brooke ileostomy subgroup, direct medical costs on average were reduced by $12,529 (P < 0.001, bootstrapped 95{\%} confidence interval: $6,467- $18,688) in the two years after recovery. CONCLUSION: Surgery for chronic ulcerative colitis resulted in reduced direct costs in the two years after surgical recovery. These observations suggest that surgical intervention for ulcerative colitis is associated with long-term economic benefit.",
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AU - Loftus, Jr, Edward Vincent

AU - Wolff, Bruce G.

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AU - Cima, Robert R.

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N2 - Purpose: This study was designed to test the hypothesis that patients undergoing definitive surgery for chronic ulcerative colitis have reduced direct medical costs after, as compared with before, total proctocolectomy. METHODS: A population-based cohort of patients who underwent proctocolectomy for ulcerative colitis from 1988 to 2007 was identified using the Rochester Epidemiology Project. Total direct healthcare costs were estimated from an administrative database. The primary outcome was the observed cost difference between the two-year period before surgery and the two-year period after a surgery/recovery period (surgery + 180 days). Statistical significance was assessed using paired t-tests and bootstrapping methods. Demographic data were presented as median (interquartile range) or frequency (proportion). Mean costs are reported in 2007 constant dollars. RESULTS: Sixty patients were Olmsted County, Minnesota, residents at the time of surgery and for the entire period of observation. Overall 40 patients (66%) were men, median age was 42 (range, 31-52) years, and duration of median colitis was four (range, 1-11) years. Operations included ileal pouch-anal anastomosis (n = 45, mean cost of surgery/recovery period = $50,530) and total proctocolectomy with Brooke ileostomy (n = 15, mean cost of surgery/recovery period = $39,309). In the pouch subgroup, direct medical costs on average were reduced by $9,296 (P < 0.001, bootstrapped 95% confidence interval: $324-$15,628) during the two years after recovery. In the Brooke ileostomy subgroup, direct medical costs on average were reduced by $12,529 (P < 0.001, bootstrapped 95% confidence interval: $6,467- $18,688) in the two years after recovery. CONCLUSION: Surgery for chronic ulcerative colitis resulted in reduced direct costs in the two years after surgical recovery. These observations suggest that surgical intervention for ulcerative colitis is associated with long-term economic benefit.

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