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. 20–30% of patients with UC will undergo surgery at some point. Healthcare costs 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 prior to the first non-elective 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 leading up to the first non-elective admission for UC, the total number of spells in an inpatient setting was 11840. The total cost of spells in the inpatient setting was £16,684,754.40, with a significant proportion due to non-elective inpatient spells (£11,260,032.35). Total cost of scopes in this inpatient group was £1,625,924.36.There were 58647 outpatient attendances, with a total attributable cost of £5,723,692.72. The cost of outpatient scopes came to £27,984.98. In comparison there were 8910 outpatient gastro attendances with a total cost of £2,340,088.18. Outpatient gastro scopes totalled £7,937.86.There were 8839 general A&E attendances with 908 emergency gastro attendances, costing £841,806.03 and £94,756.97 respectively.
Conclusion The cost associated with non-elective inpatient spells makes up a significant proportion of the total cost of inpatient spells. The lifetime risk of acute severe colitis, requiring admission in a person with UC is between 15–25%.1,2 Non elective inpatient spells and A&E attendances may reflect poor access to specialist care, long wait times for consultation, referral for diagnostic endoscopies and appropriate treatment.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, preventing non-elective 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