Health Care Resource Use and Predictors for Biologic Therapy in Patients with Crohnʼs Disease in 5 European Countries

Abstract

Purpose: Hospitalization costs associated with Crohn's disease (CD) represent a substantial economic burden. We sought to examine health care resource use for treatment of CD and to identify predictors of future use of biologic therapy in 5 European countries.Table: CD-related hospitalizations in the previous 12 Months: % (average number per patient)Methods: Data were from the Adelphi CD Disease Specific Programme, which enrolled 2,969 patients in the United Kingdom (UK), Spain, France, Italy, and Germany in 2008. Three hundred physicians and 1,657 patients completed questionnaires on CD symptoms and quality of life. Physicians also completed a patient-record form describing CD symptoms, health service use, and progression of disease. Numbers of hospitalizations and emergency department visits were calculated according to disease severity for patients from each country. Biologic use in 5 countries and potential predictors of future biologic use (CD severity at diagnosis based on patient record, presence of anal abscesses/fistulas at the time of diagnosis, disease duration, sex, and age) were also examined. Results: Of 2,964 patients included in the analysis, 35% had moderate CD and 8% had severe CD. Mean age was 38 years. Mean CD duration was 53 months (63 and 50 months for patients with moderate and severe CD, respectively [p<0.05]). CD-related hospitalization during the previous 12 months was reported by 27% of patients with moderate CD and 50% of patients with severe CD, with averages of 0.33 and 0.67 hospitalizations per patient, respectively. CD-related hospitalization by country is shown in the table. Rates of biologic use varied by country: UK, 17%; Spain, 22%; France, 34%; Italy, 22%; and Germany, 16%. Mean±SD time from diagnosis to initiation of biologic therapy was 4.4±5.3 years. From a multivariate analysis of 1,637 patients, significant predictors of future biologic use included severity of CD at time of diagnosis and presence of anal abscess/fistula at diagnosis (odds ratio=15.0 for severe vs. mild, 4.2 for moderate vs. mild, and 2.6 for presence of anal abscess/fistula; all p<0.001). Conclusion: A substantial percentage of patients, including many patients with moderate CD, reported CD-related hospitalization during the previous year. More severe disease at the time of diagnosis was predictive of future use of biologic therapy. Evaluation of the benefits of changes in current therapeutic approaches, including use of biologics, may be warranted in patients with moderate CD. Disclosure: Dr Louis - Research grant: AstraZeneca, Schering-Plough; Speaker fee: AstraZeneca, UCB, Abbott, Schering-Plough, Ferring; Advisory board member: Abbott, UCB, Ferring Dr Loftus - Consulting fees: Abbott; Research support: Abbott Schering-Plough: Grant/research support; Elan Pharmaceuticals: Consulting fees; UCB Pharma: Consulting fees, research support; Procter & Gamble Pharmaceuticals: Consulting fees, research support; Salix Pharmaceuticals: Consulting fees; PDL BioPharma: Consulting fees, research support; Otsuka America Pharmaceuticals Inc.: research support; ActoGeniX: research support Dr Mulani - Abbott: Employee, stocks Dr Chao - Abbott: Employee, stocks. This research was supported by an industry grant from This research was funded by Abbott Laboratories, Abbott Park, IL.