P2615 - Patients With Pouchitis Demonstrate a Significant Cost Burden in the First Two Years After Ileal Pouch-Anal Anastomosis

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Edward L. Barnes, MD, MPH

University of North Carolina Chapel Hill
Chapel Hill, NC, United States

Edward L. Barnes, MD, MPH, Michael Kappelman, MD, MPH, Xian Zhang, PhD, Millie D. Long, MD, MPH, FACG, Robert Sandler, MD, MPH, Hans Herfarth, MD, PhD
University of North Carolina Chapel Hill, Chapel Hill, NC

Introduction: Pouchitis is the most common complication after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). We aimed to compare the total costs among patients diagnosed with pouchitis in the first 2 years after IPAA to those among patients without pouchitis.

Methods: We identified all patients who underwent proctocolectomy with IPAA for UC in the IQVIA Legacy PharMetrics Adjudicated Claims Database, from January 2007 through June 2016. Using a validated definition for pouchitis, we compared total annual costs between those patients who developed pouchitis and those who did not develop pouchitis within the first 2 years after IPAA. In secondary analyses, we compared specific etiologies of costs including Emergency Department (ED) visits, inpatient admissions, and pouchoscopies. To illustrate trends in costs over time, we compared mean monthly costs in the 6 months prior to colectomy to those in the first and second year after IPAA.

Results: Among 547 patients who underwent IPAA, patients with pouchitis demonstrated higher total mean costs in the first and second year after IPAA as compared to patients without pouchitis (Year 1: $18,128 vs. $14,284, P=0.064 and Year 2: $21,617 vs. $10,898, P< 0.001, Table 1). Patients with pouchitis were also more likely to be evaluated in the ED during the study period (35% vs. 25%, P=0.011) leading to higher mean ED-associated costs in both years (Year 1: $758 vs. $252, P=0.001; Year 2: $1,593 vs. $162, P< 0.001). There were no significant differences in pouchoscopy-associated costs between the two groups. Mean costs per month were lower in the first 2 years after IPAA for patients with and without pouchitis when compared to the mean monthly costs in the 6 months prior to colectomy, with the exception of ED-associated costs among patients with pouchitis (Figure 1).

Discussion: In an evaluation of administrative claims from the United States, patients with pouchitis demonstrated a significant cost burden in the first 2 years after IPAA, indicating the need to explore strategies for the early diagnosis of pouchitis in an effort to employ more cost-effective management strategies.

Figure: Figure 1. Comparison of mean monthly costs by category among patients who developed pouchitis and those who did not develop pouchitis, evaluated in the 6 months pre-colectomy, first year after IPAA, and second year after IPAA

Legend: A: Total Costs; B: Costs for inpatient admission; C: Emergency Department costs; D: Costs for outpatient physician visit; E: Pharmacy costs

	Patients without Pouchitis n=287		Patients with Pouchitis n=260		p-value
Year 1 Costs	Mean	SD	Mean	SD	0.064
Total Costs	$14,284	$27,213	$18,128	$28,616	0.508
Inpatient Admission	$5,292	$18,187	$6,727	$18,944	0.001
Emergency Department	$252	$1,173	$758	$7,547	0.471
Outpatient Physician's Office	$2,761	$9,450	$2,766	$6,785	0.106
Pouchoscopy	$61	$279	$279	$747	0.588
Pharmacy	$2,055	$4,694	$2,549	$4,370	0.369
Antibiotic Specific	$8	$77	$8	$51

Year 2 Costs
Total Costs	$10,898	$25,952	$21,617	$38,739	< 0.001
Inpatient Admission	$2,780	$13,688	$7,148	$21,335	0.630
Emergency Department	$162	$729	$1,593	$16,825	< 0.001
Outpatient Physician's Office	$1,923	$5,396	$2,822	$11,395	0.015
Pouchoscopy	$91	$366	$291	$650	0.716
Pharmacy	$2,219	$5,121	$3,403	$6,088	0.084
Antibiotic-Specific	$11	$89	$14	$80	0.220

Table: Table 1. Comparison of costs in the first two years after ileal pouch-anal anastomosis among patients who developed pouchitis and those who did not

Disclosures:

Edward Barnes: AbbVie, Inc. – Consultant. Gilead – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member. Target RWE – Consultant.

Michael Kappelman indicated no relevant financial relationships.

Xian Zhang indicated no relevant financial relationships.

Millie Long: AbbVie, Inc. – Consultant. Janssen – Consultant. Pfizer – Consultant, Grant/Research Support. Salix – Consultant. Takeda Pharmaceuticals – Consultant, Grant/Research Support. Target RWE – Consultant. UCB – Consultant. Valeant – Consultant.

Robert Sandler indicated no relevant financial relationships.

Hans Herfarth: Alivio – Consultant. AMAG – Consultant. Artizan Biosciences – Grant/Research Support. Finch – Consultant. Gilead – Consultant. Lycera – Consultant. Merck – Consultant. Otsuka – Consultant. Pfizer – Consultant, Grant/Research Support. PureTech – Consultant. Seres – Consultant.

Edward L. Barnes, MD, MPH, Michael Kappelman, MD, MPH, Xian Zhang, PhD, Millie D. Long, MD, MPH, FACG, Robert Sandler, MD, MPH, Hans Herfarth, MD, PhD. P2615 - Patients With Pouchitis Demonstrate a Significant Cost Burden in the First Two Years After Ileal Pouch-Anal Anastomosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.