title: Health care costs of complex perianal fistula in Crohn's disease.
abstract: OBJECTIVE
  To evaluate the use of health care resources and the associated costs of complex perianal Crohn's disease (CD) from the National Health System perspective.
  
  
  METHODS
  We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review.
  
  
  RESULTS
  We recorded 527 treatments: 73.1% pharmacological (32.3% antibiotic, 20.5% immunomodulator, 20.3% biological) and 26.9% surgical. Mean annual global cost was €8,289/patient, 75.3% (€6,242) of which was accounted for by pharmacological treatments (€13.44 antibiotics; €1,136 immunomodulators; €5,093 biological agents), 12.4% (€1,027) by hospitalizations and surgery, 7.7% (€640) by medical visits, 4.2% (€350) by laboratory/diagnostic tests, and 0.4% (€30) by emergency department visits.
  
  
  CONCLUSIONS
  Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.
authors.affiliation: Servicio de Aparato Digestivo del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Playa de Mojácar 29. Urb Bonanza, 28669, Boadilla del Monte, Madrid, Spain, mariachs2005@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Chaparro
authors.forename: C
authors.initials: C
authors.lastname: Zanotti
authors.forename: P
authors.initials: P
authors.lastname: Burgueño
authors.forename: I
authors.initials: I
authors.lastname: Vera
authors.forename: F
authors.initials: F
authors.lastname: Bermejo
authors.forename: I
authors.initials: I
authors.lastname: Marín-Jiménez
authors.forename: C
authors.initials: C
authors.lastname: Yela
authors.forename: P
authors.initials: P
authors.lastname: López
authors.forename: M D
authors.initials: MD
authors.lastname: Martín
authors.forename: C
authors.initials: C
authors.lastname: Taxonera
authors.forename: B
authors.initials: B
authors.lastname: Botella
authors.forename: R
authors.initials: R
authors.lastname: Pajares
authors.forename: A
authors.initials: A
authors.lastname: Ponferrada
authors.forename: M
authors.initials: M
authors.lastname: Calvo
authors.forename: A
authors.initials: A
authors.lastname: Algaba
authors.forename: L
authors.initials: L
authors.lastname: Pérez
authors.forename: B
authors.initials: B
authors.lastname: Casis
authors.forename: J
authors.initials: J
authors.lastname: Maté
authors.forename: J
authors.initials: J
authors.lastname: Orofino
authors.forename: N
authors.initials: N
authors.lastname: Lara
authors.forename: M
authors.initials: M
authors.lastname: García-Losa
authors.forename: X
authors.initials: X
authors.lastname: Badia
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003424:Crohn Disease / Q000150:complications / Q000191:economics* / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000191:economics* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies
references.citation: Eur J Gastroenterol Hepatol. 2005 Oct;17(10):1047-52
references.pmid: 16148549
references.citation: Pharmacoeconomics. 2002;20(10):639-52
references.pmid: 12162753
references.citation: Isr Med Assoc J. 2007 Mar;9(3):163-8
references.pmid: 17402327
references.citation: Gastroenterology. 2007 Jan;132(1):52-65
references.pmid: 17241859
references.citation: Gastroenterology. 2001 Jun;120(7):1640-56
references.pmid: 11375946
references.citation: Dis Colon Rectum. 2009 Apr;52(4):646-50
references.pmid: 19404069
references.citation: J Clin Gastroenterol. 1992 Jun;14(4):309-17
references.pmid: 1607607
references.citation: Scand J Gastroenterol. 1997 Nov;32(11):1134-9
references.pmid: 9399395
references.citation: Aliment Pharmacol Ther. 2007 Nov 15;26(10):1313-23
references.pmid: 17850419
references.citation: Aliment Pharmacol Ther. 2003 May 1;17(9):1145-51
references.pmid: 12752351
references.citation: Inflamm Bowel Dis. 2008 Dec;14(12):1707-14
references.pmid: 18618630
references.citation: J Clin Gastroenterol. 2002 Aug;35(2):151-6
references.pmid: 12172361
references.citation: Gastroenterology. 2005 Apr;128(4):862-9
references.pmid: 15825070
references.citation: Gastroenterology. 1999 Jul;117(1):49-57
references.pmid: 10381909
references.citation: J Clin Gastroenterol. 1992 Jun;14(4):318-27
references.pmid: 1607608
references.citation: Dig Liver Dis. 2007 Oct;39(10):963-9
references.pmid: 17720635
references.citation: Dis Colon Rectum. 2002 Jun;45(6):771-5
references.pmid: 12072629
references.citation: Int J Technol Assess Health Care. 2004 Summer;20(3):274-9
references.pmid: 15446756
references.citation: N Engl J Med. 2004 Feb 26;350(9):876-85
references.pmid: 14985485
references.citation: Am J Gastroenterol. 2000 Aug;95(8):1955-60
references.pmid: 10950042
references.citation: Dig Liver Dis. 2003 Dec;35(12):853-61
references.pmid: 14703880
references.citation: Aliment Pharmacol Ther. 2005 Dec;22(11-12):1107-13
references.pmid: 16305724