Healthcare Pathways And Burden of Disease of Patients With Inflammatory Bowel Diseases (Ibd)


      Inflammatory Bowel Diseases (IBD), which include Crohn’s disease and Ulcerative Colitis, are chronic and life-long conditions. Only symptomatic reliefs exist, because the exact cause is not entirely understood. The aim of this study was to analyze the healthcare profile and the overall cost of patients with IBD in the real clinical practice.


      From ARNO Observatory database we carried out a record linkage analysis of disease exemptions, drug prescriptions and hospital discharges on 2.664.778 subjects, with available, complete and good quality data. Hospitalizations and specialist services of every single patient with IBD were followed up to 3 years after the accrual (from 01/01/2009 to 31/12/2009), while pharmaceutical data were collected up to 4 years. All pharmaceutical prescriptions, hospital care (re-hospitalizations, gastro-intestinal surgery, in-hospital mortality), diagnostic procedures and their costs (mean patient/year) were analyzed.


      25.427 patients with IBD (50,5% female, mean 56,7±18,7 y.o.) received specific drugs: intestinal antinflammatory agents (92,4%), intestinal antinfectives/antibacterials for systemic use (49,7%) the most prescribed and immunosoppressants the most expensive. As non-specific therapy, patients with IBD received Protonic Pomp Inhibitors (62,3%) and antibacterials for systemic use (Penicillins – 58%, Macrolides – 39% and Quinolones – 35,8%) prescriptions. Focus on hospitalizations revealed: cancer chemotherapy was the first cause of day-hospital admissions and the most expensive one; 8,4% of patients had cardiovascular comorbidities; the most frequent re-hospitalizations of men aged 15-44 years; the most prevalent in-hospital mortality of women aged ≥ 80 years. The 1-year follow-up costs analysis provided that hospitalizations were the most expensive (54,4% /total expenditure, mean cost 1.168€/patient) and that specific drugs accounted only for the 9,4%.


      In-hospital cares are the main cost driver for patients with IBD. This must be considered by LHUs and Physicians when evaluating patient healthcare pathways with chronic disease and estimating costs of illness. ARNO Observatory represents an important tool to support clinical governance.