Relationship between disease severity and quality of life and assessment of health care utilization and cost for ulcerative colitis in Australia: a cross-sectional, observational study

Peter R Gibson; Carolynne Vaizey; Christopher M Black; Rebecca Nicholls; Adèle R Weston; Peter Bampton; Miles Sparrow; Ian C Lawrance; Warwick S Selby; Jane M Andrews; Alissa J Walsh; David J Hetzel; Finlay A Macrae; Gregory T Moore; Martin D Weltman; Rupert W Leong; Tao Fan

doi:10.1016/j.crohns.2013.11.017

Relationship between disease severity and quality of life and assessment of health care utilization and cost for ulcerative colitis in Australia: a cross-sectional, observational study

J Crohns Colitis. 2014 Jul;8(7):598-606. doi: 10.1016/j.crohns.2013.11.017. Epub 2013 Dec 15.

Authors

Peter R Gibson¹, Carolynne Vaizey², Christopher M Black³, Rebecca Nicholls⁴, Adèle R Weston⁵, Peter Bampton⁶, Miles Sparrow⁷, Ian C Lawrance⁸, Warwick S Selby⁹, Jane M Andrews¹⁰, Alissa J Walsh¹¹, David J Hetzel¹², Finlay A Macrae¹³, Gregory T Moore¹⁴, Martin D Weltman¹⁵, Rupert W Leong¹⁶, Tao Fan¹⁷

Affiliations

¹ Alfred Hospital, Australia; Monash University, Clayton, Victoria, Australia. Electronic address: Peter.Gibson@monash.edu.
² St. Mark's Hospital, London, United Kingdom. Electronic address: cvaizey@nhs.net.
³ St. John's University, Queens, New York, USA; Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA. Electronic address: christopher.black2@merck.com.
⁴ OptumInsight, Sydney, New South Wales, Australia. Electronic address: Rebecca.Nicholls@optum.com.
⁵ OptumInsight, Sydney, New South Wales, Australia. Electronic address: adele.weston@optum.com.
⁶ Flinders Private Hospital, Bedford Park, Southern Australia, Australia. Electronic address: peter.bampton@flinders.edu.au.
⁷ Alfred Hospital, Australia. Electronic address: M.Sparrow@alfred.org.au.
⁸ Centre for Inflammatory Bowel Diseases, School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. Electronic address: ian.lawrance@uwa.edu.au.
⁹ Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia. Electronic address: warwicks@sydney.edu.au.
¹⁰ IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: Jane.Andrews@health.sa.gov.au.
¹¹ St. Vincent's Hospital, Sydney, New South Wales, Australia. Electronic address: alissa.walsh@gmail.com.
¹² East Adelaide Medical Centre, Adelaide, Southern Australia, Australia. Electronic address: David.Hetzel@health.sa.gov.au.
¹³ Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: Finlay.Macrae@mh.org.au.
¹⁴ Monash University, Clayton, Victoria, Australia; Monash Medical Centre, Clayton, Victoria, Australia. Electronic address: gregory.moore@monash.edu.
¹⁵ Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia. Electronic address: Martin.Weltman@swahs.health.nsw.gov.au.
¹⁶ Concord Hospital, Sydney, New South Wales, Australia. Electronic address: rupertleong@unsw.edu.au.
¹⁷ Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA. Electronic address: tao_fan@merck.com.

PMID: 24345767
DOI: 10.1016/j.crohns.2013.11.017

Abstract

Background & aims: The burden of ulcerative colitis (UC) in relation to disease severity is not well documented. This study quantitatively evaluated the relationship between disease activity and quality of life (QoL), as well as health care utilization, cost, and work-related impairment associated with UC in an Australian population.

Methods: A cross-sectional, noninterventional, observational study was performed in patients with a wide range of disease severity recruited during routine specialist consultations. Evaluations included the Assessment of Quality of Life-8-dimension (AQoL-8D), EuroQol 5-dimension, 5-level (EQ-5D-5L), the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ), and the Work Productivity and Activity Impairment (WPAI) instrument. The 3-item Partial Mayo Score was used to assess disease severity. Health care resource utilization was assessed by chart review and patient questionnaires.

Results: In 175 patients, mean (SD) AQoL-8D and EQ-5D-5L scores were greater for patients in remission (0.80 [0.19] and 0.81 [0.18], respectively) than for patients with active disease (0.70 [0.20] and 0.72 [0.19], respectively, both Ps<0.001). IBDQ correlated with both AQoL-8D (r=0.73; P<0.0001) and EQ-5D-5L (0.69; P<0.0001). Mean 3-month UC-related health care cost per patient was AUD $2914 (SD=$3447 [mean for patients in remission=$1970; mild disease=$3736; moderate/severe disease=$4162]). Patients in remission had the least work and activity impairment.

Conclusions: More severe UC disease was associated with poorer QoL. Substantial health care utilization, costs, and work productivity impairments were found in this sample of patients with UC. Moreover, greater disease activity was associated with greater health care costs and impairment in work productivity and daily activities.

Keywords: Disease severity; Health care utilization; Quality of life; Ulcerative colitis; Utility.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Australia
Colitis, Ulcerative / economics*
Colitis, Ulcerative / therapy
Cross-Sectional Studies
Drug Costs
Efficiency
Female
Health Care Costs*
Health Services / economics
Health Services / statistics & numerical data*
Hospitalization / economics
Humans
Male
Middle Aged
Quality of Life*
Retrospective Studies
Severity of Illness Index*
Surveys and Questionnaires
Work Capacity Evaluation
Young Adult