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16. INFLAMMATORY BOWEL DISEASE IN THE COMMUNITY: DISEASE PROFILE, HEALTHCARE UTILIZATION, IMPACT ON LIFESTYLE AND PRODUCTIVITY
  1. M.A. Asante
  1. Dept of Gastroenterology, Bromley Hospital, Kent, UK
  1. P.S. Babu,
  2. R.V. Heatley
  1. Liver Unit, St James's University Hospital, Beckett Street, Leeds, UK
  1. S. Verma,
  2. H.H. Tsai,
  3. M.H. Giaffer
  1. Dept of Gastroenterology, Hull Royal Infirmary, Anlaby Road, Hull HU13 OEL, UK

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Aim: To ascertain demographic and clinical characteristics, healthcare utilisation and impact of disease on lifestyle/productivity in community patients with inflammatory bowel disease (IBD).

Methods: Anonymised structured questionnaires were mailed to all NACC members in the Bromley and Dartford area with IBD in March 2000. Data was collected on demography, type of IBD, duration of IBD and nature of specialist care. Annual frequency of consultations in primary/secondary care, hospitalisations for IBD, frequency of radiological/endoscopic investigations, surgical operation rates, use of medications/complimentary therapy was also ascertained. The impact of IBD on lifestyle/productivity was also determined.

Results: 107 out of 266 patients with IBD responded (40% response rate). Mean duration of NACC membership 6.1yrs. Sex (M:F) 38:69. Age n(%): <40yrs 39(36%), 40–70yrs 47(44%), >70yrs 18(17%). 14(13%) smoked regularly. 60(56%) had ulcerative colitis(UC), 44(41%) had Crohn's disease (CD). Mean duration of illness was 12.6yrs [UC vs CD; 9.8 vs 16.7, p=0.0056]. 84(79%) were under Gastroenterologist care and 24(22%) under surgical care. In addition 10(9%) were under other specialities for complications. Use of healthcare resources: In previous 12 months, mean frequency of visits to GP was 2.2, (range 0–16) and to hospital specialists 2.2, (range 0–14). Frequency of Abdominal radiology and colonoscopies over previous 5 years was mean(range) 1.7(0–29) and 1.3(0–7) respectively. Hospital admission rate over the past 12 months was 18/107(17%)[UC vs CD, 12% vs 25%, NS] and Lifetime surgical operation rate 33/107(31%)[UC vs CD, 8% vs 65 p<0.0001]. Medications: Patients took a mean of 6.8 tablets per day[UC vs CD, NS]. 32/83(38%) had been non-compliant in past one month. Patients were on the following medications n(%); 23(21%) on prednisolone[UC vs CD, NS], 6(6%) on budesonide, 87(81.3%) on 5ASA[UC vs CD, NS], 22(21%) on Azathioprine[UC vs CD, NS], 18(17%) on calcium tablets, 13(12%) on acid suppressants. Only 7/23(31%) of patients on prednisolone were on calcium tablets. 6/22(27%) of patients on azathioprine were on prednisolone as well. 28/107(26%) had used complimentary therapy for IBD. Effect on lifestyle: 83(77%) patients with IBD over the previous one month had no or minimal limitation of lifestyle. In the previous 6 months, the mean days lost off work was 5.1 (range 0–99)[UC vs CD, NS].

Conclusion: IBD patients in the community place substantial pressures on healthcare but majority enjoy relatively good health with few limitations on employment and lifestyle.

17. AN ANALYSIS OF THE HOSPITAL COSTS OF INFLAMMATORY BOWEL DISEASE IN UK

The economic burden of inflammatory bowel disease (IBD) on society and health care systems is high due their occurrence during the economically productive years and chronic nature. Published literature on the economics of IBD are however limited and this has relevance with the introduction of new expensive treatments such as anti-TNF antibody.

Aim: To examine the total hospital costs of IBD patients over a year.

Methods: 100 consecutive IBD patients attending our multidisciplinary clinic were studied. Patient records were studied to collect data on the number of outpatient attendances, inpatient hospital days, cost of laboratory, radiological, endoscopic investigations and treatment costs incurred per patient over a 12-month period.

Results: 62 patients with ulcerative colitis and 38 with Crohns disease were studied. There were 44 male and 56 female patients. The mean age for both sexes combined were 47.8yrs (18–79) for UC and 46.5yrs (21–84) for Crohns. The median disease duration was 126.5 months (13–456) and 174 months (16–456) for UC and Crohns respectively. The mean total costs per patient per year for UC was £1096 (95%CI 855–1337) and £2184 (95%CI 1433–2935) for Crohns respectively. As the data was skewed the calculated median charges were lower than the mean, £903 (80–4644) for UC and £1276 (98–9534) for Crohns. The following table illustrates costs for UC and Crohns represented as mean with 95% CI intervals.

Abstract 17, Table 1

The percentage of total costs for ulcerative colitis and Crohns disease are as follows, Inpatient 13% & 43%, Outpatient 19.1% & 12.2%, Investigations 23.5% & 15.4% and Medications 44.4% & 29.4%.

Conclusion: The hospital costs of IBD patients are high. This is particularly relevant with the availability of newer treatments, which are expensive but could reduce the inpatient hospital days and avoid surgery and thus prove to be cost effective.

327. DOES BETTER DISEASE RELATED EDUCATION IMPROVE QUALITY OF LIFE? A SURVEY OF IBD PATIENTS

Background and aims: The importance of Health Related Quality of Life (HRQOL) assessment in patients with chronic disorders such as inflammatory bowel disease (IBD) is now acknowledged by researchers. Of the many factors which may influence HRQOL, patient knowledge of the condition and disease related information provision have hitherto not been studied.

Patients and methods: 250 patients with inactive IBD (UC=122, CD=128) were randomly chosen from our IBD clinic. Two sets of questionnaires (initially a standard questionnaire to assess level of disease related information (PIS), followed by a HRQOL questionnaire) were sent to each patient. In the PIS a score of 7 or more indicated satisfactory disease related knowledge and in the HRQOL a scores less than 51 suggested a normal QOL, and a score above 60 significantly impaired QOL.

Results: 168 patients (66%) returned both the questionnaires (UC=91, CD=77). The mean QOL in patients with UC and CD was 62.2 ± 8.3 and 63.9 ± 9.5 respectively, (p=ns). 99 patients (59%) had significantly impaired QOL (mean score 65 ± 7.6) with only 12 patients (8%), 6 in each group, having a normal QOL. Mean PIS score for the patients was 7.04 ± 0.1. 53% of the UC patients and 75% of the CD patients (p=0.006) were considered well informed (ie. PIQ scores of 7 or more). The mean PIS for UC patients was 6.5 ± 0.4 vs 7.5 ± 0.2 for the CD group (p=0.001). There was however no correlation seen between the QOL and PIS scores, both for UC and CD patients (r=0.3).

Conclusion: Most patients with IBD have impaired QOL, inspite of having inactive disease. The level of disease related knowledge appears to be better in patients with CD, though that does not seem to affect QOL.

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