Effect of phenotype on health care costs in Crohn's disease: A European study using the Montreal classification

Selwyn Odes, Hillel Vardi, Michael Friger, Frank Wolters, Ole Hoie, Bjørn Moum, Tomm Bernklev, Hagit Yona, Maurice Russel, Pia Munkholm, Ebbe Langholz, Lene Riis, Patrizia Politi, Paolo Bondini, Epameinondas Tsianos, Kostas Katsanos, Juan Clofent, Severine Vermeire, João Freitas, Iannis MouzasCharles Limonard, Colm O'Morain, Estela Monteiro, Giovanni Fornaciari, Morten Vatn, Reinhold Stockbrugger

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: Crohn's disease (CD) is a chronic inflammation of the gastrointestinal tract associated with life-long high health care costs. We aimed to determine the effect of disease phenotype on cost. Methods: Clinical and economic data of a community-based CD cohort with 10-year follow-up were analyzed retrospectively in relation to Montreal classification phenotypes. Results: In 418 patients, mean total costs of health care for the behavior phenotypes were: nonstricturing-nonpenetrating 1690, stricturing 2081, penetrating 3133 and penetrating-with-perianal-fistula 3356 €/patient-phenotype-year (P < 0.001), and mean costs of surgical hospitalization 215, 751, 1293 and 1275 €/patient-phenotype-year respectively (P < 0.001). Penetrating-with-perianal-fistula patients incurred significantly greater expenses than penetrating patients for total care, diagnosis and drugs, but not surgical hospitalization. Total costs were similar in the location phenotypes: ileum 1893, colon 1748, ileo-colonic 2010 and upper gastrointestinal tract 1758 €/patient-phenotype-year, but surgical hospitalization costs differed significantly, 558, 209, 492 and 542 €/patient-phenotype-year respectively (P < 0.001). By multivariate analysis, the behavior phenotype significantly impacted total, medical and surgical hospitalization costs, whereas the location phenotype affected only surgical costs. Younger age at diagnosis predicted greater surgical expenses. Conclusions: Behavior is the dominant phenotype driving health care cost. Use of the Montreal classification permits detection of cost differences caused by perianal fistula.

Original languageEnglish
Pages (from-to)87-96
Number of pages10
JournalJournal of Crohn's and Colitis
Volume1
Issue number2
DOIs
StatePublished - 1 Dec 2007

Keywords

  • Behavior phenotype
  • Crohn's disease
  • Health care cost
  • Location phenotype
  • Montreal classification

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