TY - JOUR
T1 - Clinical and economic outcomes in a population-based European cohort of 948 ulcerative colitis and Crohn's disease patients by Markov analysis.
AU - Odes, S.
AU - Vardi, H.
AU - Friger, M.
AU - Esser, D.
AU - Wolters, F.
AU - Moum, B.
AU - Waters, H.
AU - Elkjaer, M.
AU - Bernklev, T.
AU - Tsianos, E.
AU - O'Morain, C.
AU - Stockbrugger, R.
AU - Munkholm, P.
AU - Langholz, E.
PY - 2010/4/1
Y1 - 2010/4/1
N2 - SUMMARY Background Forecasting clinical and economic outcomes in ulcerative colitis (UC) and Crohn's disease (CD) patients is complex but necessary. Aim To determine: (1) frequency of treatment-classified clinical states, (2) probability of transition between states, (3) economic outcomes. Methods Newly diagnosed UC and CD patients, allocated into seven clinical states by medical and surgical treatments recorded in serial 3-month cycles, underwent Markov analysis. Results Over 10 years, 630 UC and 318 CD patients had 22,823 and 11,871 cycles. The most frequent clinical outcomes were medical/surgical remission (medication-free) and mild disease (on 5-aminosalicylates, antibiotics, topical corticosteroids), comprising 28% and 62% of UC cycles respectively; 24% and 51% of CD cycles. The probability of drug-response in patients receiving systemic corticosteroids/immunomodulators was 0.74 in UC, 0.66 in CD. Both diseases had similar likelihood of persistent drug-dependency or drug-refractoriness. Surgery was more probable in CD, 0.20, than UC, 0.08. Apropos economic outcomes, surgery was costlier in UC per cycle, but the outlay over 10 years was greater in CD. Drug-refractory UC and CD cases engendered high costs in the cohort. Conclusions Most patients on 5-aminosalicylates, corticosteroids and immunomodulators had favourable clinical and economic outcomes over 10 years. Drug-refractory and surgical patients exhibited greater long-term expenses.
AB - SUMMARY Background Forecasting clinical and economic outcomes in ulcerative colitis (UC) and Crohn's disease (CD) patients is complex but necessary. Aim To determine: (1) frequency of treatment-classified clinical states, (2) probability of transition between states, (3) economic outcomes. Methods Newly diagnosed UC and CD patients, allocated into seven clinical states by medical and surgical treatments recorded in serial 3-month cycles, underwent Markov analysis. Results Over 10 years, 630 UC and 318 CD patients had 22,823 and 11,871 cycles. The most frequent clinical outcomes were medical/surgical remission (medication-free) and mild disease (on 5-aminosalicylates, antibiotics, topical corticosteroids), comprising 28% and 62% of UC cycles respectively; 24% and 51% of CD cycles. The probability of drug-response in patients receiving systemic corticosteroids/immunomodulators was 0.74 in UC, 0.66 in CD. Both diseases had similar likelihood of persistent drug-dependency or drug-refractoriness. Surgery was more probable in CD, 0.20, than UC, 0.08. Apropos economic outcomes, surgery was costlier in UC per cycle, but the outlay over 10 years was greater in CD. Drug-refractory UC and CD cases engendered high costs in the cohort. Conclusions Most patients on 5-aminosalicylates, corticosteroids and immunomodulators had favourable clinical and economic outcomes over 10 years. Drug-refractory and surgical patients exhibited greater long-term expenses.
KW - INFLAMMATORY-BOWEL-DISEASE
KW - EVIDENCE-BASED CONSENSUS
KW - COST
KW - MANAGEMENT
KW - DIAGNOSIS
KW - NORTH
KW - MORTALITY
KW - RATES
KW - SOUTH
KW - CARE
U2 - 10.1111/j.1365-2036.2009.04228.x
DO - 10.1111/j.1365-2036.2009.04228.x
M3 - Article
C2 - 20047578
SN - 0269-2813
VL - 31
SP - 735
EP - 744
JO - Alimentary Pharmacology & Therapeutics
JF - Alimentary Pharmacology & Therapeutics
IS - 7
ER -