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Impact of Crohn's perianal fistulas on healthcare resource utilization: a US chart review study
Parakkal Deepak1, Serre-Yu Wong2, Alyssa M Parian3
1Washington University School of Medicine, St. Louis, MO, USA.
Insights
Patients with Crohn's perianal fistulas (CPF) face significant healthcare costs due to frequent visits and interventions. New fistulas incurred more outpatient visits, highlighting the need for better management strategies to reduce patient burden and healthcare resource utilization (HCRU).
Area of Science:
- Gastroenterology
- Health Services Research
Background:
- Crohn's disease frequently causes perianal fistulas (CPF), often leading to high rates of recurrence and treatment failure.
- Effective management strategies are needed to reduce the substantial healthcare resource utilization (HCRU) associated with CPF.
Purpose of the Study:
- To assess healthcare resource utilization (HCRU) in patients with new, persistent, and recurrent Crohn's perianal fistulas (CPF) in the USA.
Main Methods:
- A retrospective, multi-site medical chart review was conducted.
- Data on HCRU were collected for at least two years post-index date (January 2016 - December 2018).
- 227 patients with 236 CPF cases (new, persistent, recurrent) were analyzed.
Main Results:
- Most patients (67.0%) received medical treatments, 59.9% underwent surgery, and 42.7% had both.
- Patients experienced high rates of outpatient visits (mean 8.75 CPF-related, 18.27 all-cause) and inpatient visits (mean 0.30 CPF-related, 0.83 all-cause).
- New fistulas were associated with more outpatient visits compared to persistent/recurrent fistulas (p < 0.05).
Conclusions:
- Patients with CPF exhibit a substantial HCRU burden, necessitating multiple interventions.
- There is an unmet need for effective CPF management strategies that promote long-term healing.
- Improved management could reduce patient burden and overall HCRU.
Aim:
Perianal fistulas are a common complication of Crohn's disease. Despite the current treatment options, fistula recurrence/treatment failure rates are high. The aim of this study was to assess healthcare resource utilization (HCRU) among patients with new, persistent, and recurrent Crohn's perianal fistulas (CPF) in the USA.
Method:
A retrospective, multi-site medical chart review was conducted in patients with CPF. Data on HCRU were collected for ≥2 years after the index date (date of most-recent episode of CPF symptoms between January 2016 and December 2018).
Results:
In total, 227 patients were included among whom there were 236 fistulas: new (n = 94, 39.8%), persistent (n = 108, 45.8%), and recurrent (n = 34, 14.4%). Mean (standard deviation [SD]) age was 47.7 (13.7) years, 81.5% were White, 50.7% were male. After index (mean follow-up 33.8 months), 67.0% of patients received medical treatments, 59.9% had surgical interventions, and 42.7% received both. The mean (SD) number of CPF-related and all-cause outpatient visits was 8.75 (8.20) and 18.27 (16.96), the mean (SD) number of CPF-related and all-cause emergency room visits was 0.06 (0.27) and 0.65 (1.55), and the mean (SD) number of CPF-related and all-cause inpatient visits was 0.30 (0.79) and 0.83 (1.81), respectively. Patients with new fistulas had more CPF-related and all-cause outpatient visits and fewer all-cause inpatient visits than patients with persistent/recurrent fistulas (p < 0.05).
Limitations:
The use of biologics for underlying Crohn's disease before index was not captured. Furthermore, this study was subject to missing data and limited generalizability (most sites located in Midwest USA).
Conclusion:
There is a substantial HCRU burden among patients with CPF, likely owing to the requirement for multiple and repeated interventions, indicating an unmet need for effective management strategies that promote long-term fistula healing to ultimately support reduced patient burden and HCRU.
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