title: Relationship between disease severity and quality of life and assessment of health care utilization and cost for ulcerative colitis in Australia: a cross-sectional, observational study.
abstract: OBJECTIVE
  The burden of ulcerative colitis (UC) in relation to disease severity is not well documented. This study quantitatively evaluated the relationship between disease activity and quality of life (QoL), as well as health care utilization, cost, and work-related impairment associated with UC in an Australian population.
  
  
  METHODS
  A cross-sectional, noninterventional, observational study was performed in patients with a wide range of disease severity recruited during routine specialist consultations. Evaluations included the Assessment of Quality of Life-8-dimension (AQoL-8D), EuroQol 5-dimension, 5-level (EQ-5D-5L), the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ), and the Work Productivity and Activity Impairment (WPAI) instrument. The 3-item Partial Mayo Score was used to assess disease severity. Health care resource utilization was assessed by chart review and patient questionnaires.
  
  
  RESULTS
  In 175 patients, mean (SD) AQoL-8D and EQ-5D-5L scores were greater for patients in remission (0.80 [0.19] and 0.81 [0.18], respectively) than for patients with active disease (0.70 [0.20] and 0.72 [0.19], respectively, both Ps<0.001). IBDQ correlated with both AQoL-8D (r=0.73; P<0.0001) and EQ-5D-5L (0.69; P<0.0001). Mean 3-month UC-related health care cost per patient was AUD $2914 (SD=$3447 [mean for patients in remission=$1970; mild disease=$3736; moderate/severe disease=$4162]). Patients in remission had the least work and activity impairment.
  
  
  CONCLUSIONS
  More severe UC disease was associated with poorer QoL. Substantial health care utilization, costs, and work productivity impairments were found in this sample of patients with UC. Moreover, greater disease activity was associated with greater health care costs and impairment in work productivity and daily activities.
authors.affiliation: Alfred Hospital, Australia; Monash University, Clayton, Victoria, Australia. Electronic address: Peter.Gibson@monash.edu.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gibson
authors.affiliation: St. Mark's Hospital, London, United Kingdom. Electronic address: cvaizey@nhs.net.
authors.forename: Carolynne
authors.initials: C
authors.lastname: Vaizey
authors.affiliation: St. John's University, Queens, New York, USA; Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA. Electronic address: christopher.black2@merck.com.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Black
authors.affiliation: OptumInsight, Sydney, New South Wales, Australia. Electronic address: Rebecca.Nicholls@optum.com.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Nicholls
authors.affiliation: OptumInsight, Sydney, New South Wales, Australia. Electronic address: adele.weston@optum.com.
authors.forename: Adèle R
authors.initials: AR
authors.lastname: Weston
authors.affiliation: Flinders Private Hospital, Bedford Park, Southern Australia, Australia. Electronic address: peter.bampton@flinders.edu.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Bampton
authors.affiliation: Alfred Hospital, Australia. Electronic address: M.Sparrow@alfred.org.au.
authors.forename: Miles
authors.initials: M
authors.lastname: Sparrow
authors.affiliation: Centre for Inflammatory Bowel Diseases, School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. Electronic address: ian.lawrance@uwa.edu.au.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lawrance
authors.affiliation: Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia. Electronic address: warwicks@sydney.edu.au.
authors.forename: Warwick S
authors.initials: WS
authors.lastname: Selby
authors.affiliation: IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: Jane.Andrews@health.sa.gov.au.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Andrews
authors.affiliation: St. Vincent's Hospital, Sydney, New South Wales, Australia. Electronic address: alissa.walsh@gmail.com.
authors.forename: Alissa J
authors.initials: AJ
authors.lastname: Walsh
authors.affiliation: East Adelaide Medical Centre, Adelaide, Southern Australia, Australia. Electronic address: David.Hetzel@health.sa.gov.au.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hetzel
authors.affiliation: Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: Finlay.Macrae@mh.org.au.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.affiliation: Monash University, Clayton, Victoria, Australia; Monash Medical Centre, Clayton, Victoria, Australia. Electronic address: gregory.moore@monash.edu.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Moore
authors.affiliation: Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia. Electronic address: Martin.Weltman@swahs.health.nsw.gov.au.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Weltman
authors.affiliation: Concord Hospital, Sydney, New South Wales, Australia. Electronic address: rupertleong@unsw.edu.au.
authors.forename: Rupert W
authors.initials: RW
authors.lastname: Leong
authors.affiliation: Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA. Electronic address: tao_fan@merck.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003093:Colitis, Ulcerative / Q000191:economics* / Q000628:therapy; D003430:Cross-Sectional Studies; D016527:Drug Costs; D004526:Efficiency; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation; D055815:Young Adult
keywords: Disease severity; Health care utilization; Quality of life; Ulcerative colitis; Utility