Introduction Inflammatory Bowel Disease (IBD) has a prevalence of around 400 in 100,000 in the UK, with the prevalence of UC specifically of around 243 per 100,000. This gives a figure of 146,000 people in the UK living with UC. Around 30% of IBD patients are under regular hospital follow-up. Around 20–30% of patients with UC will undergo surgery at some point. Healthcare costs in terms of admissions and endoscopic assessment associated with Ulcerative Colitis remain poorly researched. Our objective was to calculate the costs associated with both in and outpatient attendances and endoscopies in the 24 months following the first non-elective (NE) admission for ulcerative colitis in a UK population.
Methods Hospital Episode Statistics data for 2011/2 for all clinical commissioning groups in England were analysed to calculate the cost of UC. The data used in this study were obtained from the AXON Database. AXON is a health data warehouse that provides interrogative analysis and health intelligence on Hospital Episode Statistics (HES). Each HES record has a Healthcare Resource Group (HRG) code that is linked to the national tariff. International Classification of Diseases – 10 (ICD-10) diagnosis codes related to UC were used to identify patients.
Results In the 24 months following the first NE admission for UC, there were 20444 spells in a general inpatient setting with a cost of £30,767,953.07. The cost of endoscopies from the inpatient spells was £3,535,965.45. There were 4557 inpatient gastroenterology spells with a total cost of £4,068,759.40. Cost of endoscopies during these gastroenterology specific spells amounted to £3,546,993.42. The cost of general outpatient attendances was £9,424,953.22 in comparison to £5,918,472.64 for gastroenterology outpatient attendances. Outpatient endoscopies and gastroenterology endoscopies cost £33,574.83 and £40,006.90 respectively. General A&E attendances totalled £872,666.30 with emergency gastroenterology attendances totalling £119,354.31.
Conclusion Inpatient attendances make up the greatest proportion of the total cost associated with UC in the 24 month period following the first NE admission. Episodes of severe colitis, by definition require admission for inpatient management. The lifetime risk of acute severe colitis in a person with UC is between 15–25%.2,3We have demonstrated a huge cost burden associated with these admissions. This may reflect poor access to specialist and emergency care during flares as well as delays in carrying out diagnostic investigations. There is potential for significant cost savings by way of rapid access specialist clinics and 7 day a week advice helplines run by IBD specialist nurses to enable timely review and management of patients, thus preventing the need for inpatient admissions.
References 1 Dinesen LC, Walsh AJ, Protic MN, Heap G, Cummings F, Warren BF, George B, Mortensen NJ, Travis SP. The pattern and outcome of acute severe colitis. J Crohns Colitis. 2010 Oct;4(4);431–7.
2 Edwards FC, Truelove SC. The course and prognosis of Ulcerative Colitis Gut. 1963 Dec;4:299–315.
Disclosure of Interest None Declared