title: Relationship between disease severity, quality of life and health-care resource use in a cross-section of Australian patients with Crohn's disease.
abstract: OBJECTIVE
  New treatments for Crohn's disease are expensive and place economic strain upon health-care systems, and 'value-for-money' needs to be confirmed. This study aimed to correlate disease severity with health-related quality of life and with health-care resource use, to allow evaluation of the cost effectiveness of these treatments.
  
  
  METHODS
  A cross-sectional, non-interventional, pharmacoeconomics study was performed with patients completing questionnaires comprising demographic, disease and health-care utilization questions, together with the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ) and the Assessment of Quality of Life (AQoL) multi-attribute utility instrument. The Crohn's Disease Activity Index (CDAI) was used to assess disease severity.
  
  
  RESULTS
  143 patients with a broad range of disease severity (CDAI 36-446, fistulae 23%) were recruited from referral centers. Stepwise regression analyses demonstrated a negative correlation between disease severity and both IBDQ and AQoL (both P < 0.0001). Age, gender and years since diagnosis did not impact upon either of the quality-of-life outcomes. Mean utility score for non-fistulizing patients with moderate-severe active disease (CDAI >/= 220) was 0.45, mild disease (CDAI 150-219) was 0.68 and for remission (CDAI < 150) was 0.77. Health-care resource utilization increased with increasing CDAI (P < 0.001), with hospital admissions being the largest component cost. Twenty-seven percent of patients (mean age 38 year) received a government benefit, 51% primarily due to their Crohn's disease.
  
  
  CONCLUSIONS
  Crohn's disease severity correlates with poor quality of life. Utility scores determined will permit cost-utility analyses to be made in order to best allocate limited health resources.
authors.affiliation: Monash University Department of Medicine and Department of Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia. peter.gibson@med.monash.edu.au
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gibson
authors.forename: Adèle R
authors.initials: AR
authors.lastname: Weston
authors.forename: Amelia
authors.initials: A
authors.lastname: Shann
authors.forename: Timothy H J
authors.initials: TH
authors.lastname: Florin
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lawrance
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.forename: Graham
authors.initials: G
authors.lastname: Radford-Smith
mesh_terms: D000328:Adult; D001315:Australia; D003424:Crohn Disease / Q000191:economics / Q000473:pathology / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires