title: Comparison of Costs and Quality of Life in Ulcerative Colitis Patients with an Ileal Pouch-Anal Anastomosis, Ileostomy and Anti-TNFα Therapy.
abstract: OBJECTIVE
  More data are warranted on the economic impact of different treatment strategies in ulcerative colitis (UC) patients. We compared the costs and quality of life of UC patients with a pouch reconstruction, an ileostomy or anti-tumour necrosis factor α (TNFα) therapy.
  
  
  METHODS
  UC patients filled out 3-monthly questionnaires for 2 years. Differences in 3-monthly healthcare costs, productivity costs and patient costs were tested using mixed model analysis. Quality of life was assessed employing the ) and the inflammatory bowel disease questionnaire (IBDQ).
  
  
  RESULTS
  Out of 915 UC patients, 81 (9%) had a pouch and 48 (5%) an ileostomy, and 34 (4%) were on anti-TNFα therapy. Anti-TNFα-treated patients reported high UC related-healthcare costs per 3 months (€5350). Medication use accounted for 92% of healthcare costs. UC-attributable healthcare costs were 3-fold higher in ileostomy patients compared with pouch patients (€1581 versus €407; p < 0.01). Main cost drivers in ileostomy patients were healthcare costs and ileostomy supplies (2 and 23% of healthcare costs, respectively). In pouch patients, the main cost driver was hospitalization, accounting for 50% of healthcare costs. Productivity loss did not differ between pouch and ileostomy patients (€483 versus €377; p < 0.23), but was significantly higher in anti-TNFα-treated patients (€1085). No difference was found in IBDQ scores, but pouch patients were found to have higher quality-adjusted life years than ileostomy patients and anti-TNFα-treated patients (0.90 [interquartile range 0.78-1.00] versus 0.84 [0.78-1.00] and 0.84 [0.69-1.00], respectively; p < 0.01).
  
  
  CONCLUSIONS
  Patients receiving anti-TNFα therapy reported the highest healthcare cost, in which medication use was the major cost driver. Ileostomy patients were three times more expensive than pouch patients due to frequent hospitalization and ileostomy supplies.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Mirthe E
authors.initials: ME
authors.lastname: van der Valk
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Marie-Josée J
authors.initials: MJ
authors.lastname: Mangen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Severs
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Mike
authors.initials: M
authors.lastname: van der Have
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Dijkstra
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands Department of Gastroenterology and Hepatology, Orbis Medical Centre, Sittard, The Netherlands.
authors.forename: Ad A
authors.initials: AA
authors.lastname: van Bodegraven
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Herma H
authors.initials: HH
authors.lastname: Fidder
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: de Jong
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Pierik
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: C Janneke
authors.initials: CJ
authors.lastname: van der Woude
authors.affiliation: Department of Gastroenterology and Hepatology, Orbis Medical Centre, Sittard, The Netherlands.
authors.forename: Mariëlle J L
authors.initials: MJ
authors.lastname: Romberg-Camps
authors.affiliation: Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, The Netherlands.
authors.forename: Cees H M
authors.initials: CH
authors.lastname: Clemens
authors.affiliation: Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Jansen
authors.affiliation: Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands.
authors.forename: Paul C
authors.initials: PC
authors.lastname: van de Meeberg
authors.affiliation: Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Nofel
authors.initials: N
authors.lastname: Mahmmod
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: van der Meulen-de Jong
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
authors.forename: Cyriel Y
authors.initials: CY
authors.lastname: Ponsioen
authors.affiliation: Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, The Netherlands.
authors.forename: Clemens
authors.initials: C
authors.lastname: Bolwerk
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: J Reinoud
authors.initials: JR
authors.lastname: Vermeijden
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Leenders
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands boldenbu@umcutrecht.nl.
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
mesh_terms: D000068879:Adalimumab / Q000191:economics / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000191:economics* / Q000628:therapy; D039021:Colonic Pouches / Q000191:economics; D003430:Cross-Sectional Studies; D005260:Female; D005765:Gastrointestinal Agents / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007081:Ileostomy / Q000191:economics*; D000069285:Infliximab / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009426:Netherlands; D016737:Proctocolectomy, Restorative / Q000191:economics*; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab; D000068879:Adalimumab