title: Systematic review: the financial burden of surgical complications in patients with ulcerative colitis.
abstract: BACKGROUND
  Patients undergoing colectomy for ulcerative colitis (UC) may experience complications associated with reduced quality of life (QoL), and maybe a considerable economic burden to healthcare systems. Appreciation of these burdens is important to evaluate the cost effectiveness of newer interventions for UC vs. colectomy.
  
  
  OBJECTIVE
  To identify data representing resource utilisation or costs of complications arising from colorectal procedures in patients with UC, and data representing patient QoL, as reported by health state utility values (HSUVs).
  
  
  METHODS
  Embase, MEDLINE and The Cochrane Library were searched for studies (1995-2014) reporting resource use/costs of surgical complications, and HSUVs data in adult patients with UC, undergoing colorectal procedures. Conference proceedings (January 2011-January 2014) were hand-searched.
  
  
  RESULTS
  Twelve studies reported resource use/costs, and three reported HSUVs data in patients with UC experiencing surgical complications. Additional mean costs of postoperative complications ranged from $18 650/patient with complications at a 6-month follow-up (46% incidence) to $34 714/patient with complications over a 5-year period (49% incidence). Pouchitis, pouch failure and small bowel obstruction carried the greatest burden. Marked reductions in HSUVs were observed for patients with UC experiencing surgical complications, vs. patients with UC in a remission state.
  
  
  CONCLUSIONS
  There is a paucity of well reported studies on resource use/cost, and QoL burden of surgical complications in patients with UC. However, surgical complications represent a substantial burden both in terms of cost and of quality of life, with reoperations, physician fees, additional in-patient hospital stays and infertility treatment being the main cost drivers.
authors: Endoscopy Unit, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London.
authors: J O
authors: JO
authors: Lindsay
authors: A
authors: A
authors: Bergman
authors: A S
authors: AS
authors: Patel
authors: S M
authors: SM
authors: Alesso
authors: L
authors: L
authors: Peyrin-Biroulet
mesh_terms: D000328:Adult; D003082:Colectomy / Q000191:economics / Q000379:methods*; D003093:Colitis, Ulcerative / Q000191:economics / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006801:Humans; D007902:Length of Stay / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D019449:Pouchitis / Q000191:economics / Q000209:etiology; D011788:Quality of Life