title: Ulcerative colitis-associated hospitalization costs: a population-based study.
abstract: BACKGROUND
  Hospitalization costs for ulcerative colitis (UC) following the introduction of infliximab have not been evaluated.
  
  
  OBJECTIVE
  To study predictors of costs for UC patients who were hospitalized for a flare or colectomy.
  
  
  METHODS
  Population-based surveillance identified adults (≥18 years of age) admitted to hospital for UC flare or colectomy between 2001 and 2009 in the Calgary Health Zone (Alberta). Medical charts were reviewed and patients stratified into three admission types: responsive to inpatient medical therapy (n=307); emergent colectomy (n=227); and elective colectomy (n=208). The annual median cost with interquartile range (IQR) was calculated. Linear regression determined the effect of admission type on hospital charges after adjusting for age, sex, smoking, comorbidities, disease extent, medication use (eg, infliximab) and year. The adjusted cost increase was presented as the percent increase with 95% CIs. Joinpoint analysis assessed for an inflection point in hospital cost after the introduction of infliximab.
  
  
  RESULTS
  Median hospitalization cost for UC flare, emergent colectomy and elective colectomy, respectively, were: $5,499 (IQR $3,374 to $8,904), $23,698 (IQR $17,981 to $32,385) and $14,316 (IQR $11,932 to $18,331). Adjusted hospitalization costs increased approximately 6.0% annually (95% CI 4.5% to 7.5%). Adjusted costs were higher for patients who underwent an elective colectomy (percent increase cost 179.8% [95% CI 151.6% to 211.1%]) or an emergent colectomy (percent increase cost 211.1% [95% CI 183.2% to 241.6%]) than medically responsive patients. Infliximab in hospital was an independent predictor of increased costs (percent increase cost 69.5% [95% CI 49.2% to 92.5%]). No inflection points were identified.
  
  
  CONCLUSIONS
  Hospitalization costs for UC increased due to colectomy and infliximab.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Coward
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Heitman
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
authors.forename: James
authors.initials: J
authors.lastname: Hubbard
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Proulx
authors.forename: Scott
authors.initials: S
authors.lastname: Zimmer
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.forename: Cynthia
authors.initials: C
authors.lastname: Seow
authors.forename: Yvette
authors.initials: Y
authors.lastname: Leung
authors.forename: Indraneel
authors.initials: I
authors.lastname: Datta
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: Mark
authors.initials: M
authors.lastname: Swain
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta; D003082:Colectomy / Q000191:economics / Q000639:trends; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D005260:Female; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use; D017721:Hospital Costs / Q000639:trends*; D006760:Hospitalization / Q000191:economics* / Q000639:trends; D006801:Humans; D000069285:Infliximab / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab