title: 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.
abstract: 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.
authors.affiliation: Gastroenterology and Hepatology Department, Soroka Hospital and Ben Gurion University of Negev, Beer Sheva, Israel. odes@bgumail.bgu.ac.il
authors.forename: Shmuel
authors.initials: S
authors.lastname: Odes
authors.forename: Michael
authors.initials: M
authors.lastname: Friger
authors.forename: Hillel
authors.initials: H
authors.lastname: Vardi
authors.forename: Greet
authors.initials: G
authors.lastname: Claessens
authors.forename: Xavier
authors.initials: X
authors.lastname: Bossuyt
authors.forename: Lene
authors.initials: L
authors.lastname: Riis
authors.forename: Pia
authors.initials: P
authors.lastname: Munkholm
authors.forename: Frank
authors.initials: F
authors.lastname: Wolters
authors.forename: Hagit
authors.initials: H
authors.lastname: Yona
authors.forename: Ole
authors.initials: O
authors.lastname: Hoie
authors.forename: Marina
authors.initials: M
authors.lastname: Beltrami
authors.forename: Epameinondas
authors.initials: E
authors.lastname: Tsianos
authors.forename: Kostas
authors.initials: K
authors.lastname: Katsanos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mouzas
authors.forename: Juan
authors.initials: J
authors.lastname: Clofent
authors.forename: Estela
authors.initials: E
authors.lastname: Monteiro
authors.forename: Andrea
authors.initials: A
authors.lastname: Messori
authors.forename: Patrizia
authors.initials: P
authors.lastname: Politi
authors.forename: Colm
authors.initials: C
authors.lastname: O'Morain
authors.forename: Charles
authors.initials: C
authors.lastname: Limonard
authors.forename: Maurice
authors.initials: M
authors.lastname: Russel
authors.forename: Morten
authors.initials: M
authors.lastname: Vatn
authors.forename: Bjorn
authors.initials: B
authors.lastname: Moum
authors.forename: Reinhold
authors.initials: R
authors.lastname: Stockbrugger
authors.forename: Severine
authors.initials: S
authors.lastname: Vermeire
mesh_terms: 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
chemical_list: D000908:Antibodies, Fungal; C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein