title: Length of hospital stay and associated hospital costs with infliximab versus cyclosporine in severe ulcerative colitis.
abstract: BACKGROUND
  Cyclosporine and infliximab (IFX) seem equally effective as rescue therapy in hospitalized patients with severe ulcerative colitis (UC), although associated hospital stay and costs may differ.
  
  
  OBJECTIVE
  The aim of this study was to compare the duration of hospital stay and associated costs from initiation of rescue therapy to time of discharge in hospitalized patients with corticosteroid-refractory UC receiving cyclosporine or IFX. Colectomy rates after 6 months were used as the outcome parameter for treatment success.
  
  
  METHODS
  Hospital records of patients admitted between November 2003 and August 2012 at a tertiary referral center were analyzed.
  
  
  RESULTS
  Forty-two patients were included (cyclosporine group: 26 patients; IFX group: 16 patients). Patient characteristics were comparable, with the exception that cyclosporine-treated patients more often had a pancolitis (89 vs. 63%, P=0.046). The median length of hospital stay was 11.0 (interquartile range 7.75-13.25) versus 4.0 days (interquartile range 4.0-5.75) in the cyclosporine and IFX group (P<0.01), respectively. The mean in-hospital costs were significantly higher in the cyclosporine-treated versus IFX-treated patients (6121 vs. 4853 euros, P<0.05), whereas the total costs up to 3 months after initiation of rescue therapy were significantly higher in the IFX group (6787 vs. 9983 euros, P<0.01). There were no significant differences in colectomy rates at 6 months (23 and 31% for cyclosporine and IFX, P=0.50). More side-effects were observed during treatment with cyclosporine.
  
  
  CONCLUSIONS
  Length of hospital stay and in-hospital costs have been reduced significantly since the introduction of IFX as rescue therapy for severe UC instead of cyclosporine. However, the total treatment costs are higher in IFX-treated patients.
authors.affiliation: aDepartment of Gastroenterology and Hepatology bTytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Löwenberg
authors.forename: Nicolette W
authors.initials: NW
authors.lastname: Duijvis
authors.forename: Cyriel
authors.initials: C
authors.lastname: Ponsioen
authors.forename: Gijs R
authors.initials: GR
authors.lastname: van den Brink
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Geert R A M
authors.initials: GR
authors.lastname: D'Haens
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000191:economics / Q000601:surgery; D016572:Cyclosporine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006302:Health Services Research / Q000379:methods; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D009426:Netherlands; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab