Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3860
Peer-review started: November 16, 2015
First decision: December 11, 2015
Revised: December 22, 2015
Accepted: January 30, 2016
Article in press: January 31, 2016
Published online: April 14, 2016
AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.
METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.
RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.
CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.
Core tip: The health care costs of a proactive disease-prevention post-operative Crohn’s disease strategy are substantial. Much of this cost relates to drug therapy (biologics). Active care involving endoscopic monitoring for disease recurrence, costs more than symptom-based monitoring. The occurrence of endoscopic recurrence increases costs significantly, related largely to drug therapy. Faecal calprotectin to monitor for disease recurrence can substantially decrease post-operative costs.