P376 Real life health care utilisation in paediatric patients with inflammatory bowel disease in the era of biologics

Abstract

Abstract Background The burden associated with the management of paediatric patients with inflammatory bowel disease (IBD) has been rising as the incidence of IBD is increasing in children. In addition, the widespread use of biologics and a treat-to-target approach also contributes to the increase of healthcare utilisation. Methods The purpose of this study was to assess the health care services utilisation and the associated factors in a prospective cohort of children diagnosed with IBD in Quebec, Canada. Patients diagnosed from 2013 to 2015 and followed up until the transfer to adult care were identified in our IBD database. Data on IBD related services and treatments: imaging procedures, hospitalisations and outpatient visits, medications from diagnosis to transition was extracted. We analyzed the healthcare utilisation according to the baseline disease severity (paediatric Crohn’s disease activity index or paediatric ulcerative colitis activity index) at diagnosis, and according to exposition to intravenous biologics. Results In total, 144 patients were included in the study [(77 males), CD (N = 98), UC (N = 31) and IBD-U (N = 15); median (interquartile(IQR)) age at diagnosis 15.2 (14.3–16.3) years]. The median (IQR) duration of paediatric follow-up was 2.9 (1.8–3.9) years. The median (min-max) number of imaging procedures varied largely: esophagogastroduodenoscopy 1(0–2), colonoscopy 1(1–6), abdominal ultrasound1(0–13), abdominal MRI 1(0–4), tomodensitometry 0(0–2), bone densitometry 1(0–5). Patients had various follow-up encounters (median(min–max)): outpatient visits 9(1–28), IBD nurses phone follow-ups 4(0–33). Sixty-four per cent of patients had at least one hospitalisation [median(min–max)1(0–10); median duration 4(0–150 days)] and 35.41% had at least one emergency visit. Baseline disease severity did not predict the disease burden: the mean number of encounters was 3.0/year in the moderate/severe group as compared with 2.5/year in the mild group; p = 0.61. Among the, 63.5% of patients exposed to an intravenous biologic (Infliximab or Vedolizumab), those exposed earlier (<3 months after diagnosis) used more health care services (mean = 3.3/year) than those exposed later (mean = 2.23/year); p <0.0001. In addition, the median (IQR) cumulative days of healthcare utilisation (missing school days) for patients treated with intravenous biologics was 48.5(32.4–67.9) days during paediatric care. Conclusion Adolescents with IBD have several healthcare encounters between the diagnosis and transfer to adult care. Disease severity at diagnosis was not related to a higher level of health services utilisation during follow-up. However, treatment with intravenous biologics was associated with a high health service utilisation and school missing during follow-up.