Role of ASCA and the NOD2/CARD15 mutation Gly908Arg in predicting increased surgical costs in Crohn's disease patients: a project of the European Collaborative Study Group on Inflammatory Bowel Disease.
BACKGROUND
NOD2/CARD15, the first identified susceptibility gene in Crohn's disease (CD), is associated with ileal stenosis and increased frequency of surgery. Anti-Saccharomyces cerevisiae antibody (ASCA), a serological marker for CD, is associated with ileal location and a high likelihood for surgery. We hypothesized that the presence of ASCA and NOD2/CARD15 mutations could predict increased health care cost in CD.


METHODS
CD patients in a prospectively designed community-based multinational European and Israeli cohort (n = 228) followed for mean 8.3 (SD 2.6) years had blood drawn for measurement of ASCA (IgG, IgA), Arg702Trp, Gly908Arg, and Leu1007fsinsC. Days spent in the hospital and the costs of medical and surgical hospitalizations and medications were calculated.


RESULTS
The median duration of surgical hospitalizations was longer in Gly908Arg-positive than -negative patients, 3.5 and 1.5 days/patient-year (P < 0.01), and in ASCA-positive than -negative patients, 1.1 and 0 days/patient-year (P < 0.001). Median surgical hospitalization cost was 1,580 euro/patient-year in Gly908Arg-positive versus 0 euro/patient-year in -negative patients (P < 0.01), and 663 euro/patient-year in ASCA-positive versus 0 euro/patient-year in -negative patients (P < 0.001). Differences in cost of medications between groups were not significant. The effect of Gly908Arg was expressed in countries with higher Gly908Arg carriage rates. ASCA raised surgical costs independently of the age at diagnosis of disease. Arg702Trp and Leu1007fsinsC did not affect the cost of health care.


CONCLUSIONS
Since CD patients positive for Gly908Arg and ASCA demonstrated higher health care costs, it is possible that measurement of Gly908Arg and ASCA at disease diagnosis can forecast the expensive CD patients.
Odes
Shmuel
S
Gastroenterology and Hepatology Department, Soroka Hospital and Ben Gurion University of Negev, Beer Sheva, Israel. odes@bgumail.bgu.ac.il
Friger
Michael
M
Vardi
Hillel
H
Claessens
Greet
G
Bossuyt
Xavier
X
Riis
Lene
L
Munkholm
Pia
P
Wolters
Frank
F
Yona
Hagit
H
Hoie
Ole
O
Beltrami
Marina
M
Tsianos
Epameinondas
E
Katsanos
Kostas
K
Mouzas
Ioannis
I
Clofent
Juan
J
Monteiro
Estela
E
Messori
Andrea
A
Politi
Patrizia
P
O'Morain
Colm
C
Limonard
Charles
C
Russel
Maurice
M
Vatn
Morten
M
Moum
Bjorn
B
Stockbrugger
Reinhold
R
Vermeire
Severine
S
D000293:Adolescent; D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood*; D003424:Crohn Disease / Q000097:blood / Q000191:economics* / Q000235:genetics / Q000601:surgery; D005060:Europe; D005260:Female; D013502:General Surgery / Q000191:economics*; D020022:Genetic Predisposition to Disease; D005838:Genotype; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009154:Mutation; D053473:Nod2 Signaling Adaptor Protein / Q000191:economics / Q000235:genetics*; D011446:Prospective Studies; D012440:Saccharomyces / Q000276:immunology
D000908:Antibodies, Fungal; C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein