ORIGINAL ARTICLE   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2025 January-February;184(1-2):1-8

DOI: 10.23736/S0393-3660.24.05472-X

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lingua: Inglese

Direct healthcare costs in perianal fistulizing Crohn’s disease and 21 years of biological therapy in a public health system: a real-life study

Leticia ROSEVICS ^{1, 2} ✉, Emilton LIMA JÚNIOR ², Odery RAMOS JÚNIOR ²

¹ Postgraduate Program in Internal Medicine and Health Sciences, Department of Internal Medicine, Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Paraná, Curitiba, Brazil; ² Postgraduate Program in Internal Medicine and Health Sciences, Federal University of Paraná, Curitiba, Brazil

BACKGROUND: The aim of this study was to evaluate the direct treatment costs of Crohn’s disease, particularly those of perianal fistulizing disease, and to ascertain whether antitumor necrosis factor alpha (anti-TNFα) therapy affected that, considering that Crohn’s disease is a chronic condition and costly to manage.
METHODS: This retrospective cohort study included patients with Crohn’s disease, 18 years or older, who were followed up between 2000 and 2021 in a public tertiary hospital in Brazil. Data on patient demographics and treatment - such as medications, consultations, investigations, and hospitalizations - were extracted. For group comparisons, the Student’s t-test and Mann-Whitney U Test were used. For comparative analysis with the introduction and period of anti-TNFα use, Spearman’s correlation and Wilcoxon’s tests were used. P<0.05 indicated statistical significance.
RESULTS: Of the 199 included patients, 83 had perianal fistulizing disease, 50.3% were female, and the mean age at diagnosis was 35±14 years, with 10±6 years of follow-up. The total annual cost was U.S. $5646.67±4849.60, 97% of which was for medication. Patients with perianal fistulizing disease had higher total costs of treatment. They also had more days of hospitalization, even during the period of anti-TNFα use. Total and contributory costs were lower from the number of hospitalizations, endoscopic examinations, and consultations with early introduction of anti-TNFα, but with low correlation.
CONCLUSIONS: In this real-life study, patients with perianal fistulizing disease had higher treatment costs, due particularly to medication, but early biological therapy introduction decreased the number of hospitalizations, endoscopies, and year costs.

KEY WORDS: Crohn disease; Tumor necrosis factor inhibitors; Economics; Pharmaceutical preparations