A review of hospital costs associated with inflammatory bowel disease (IBD) has highlighted the need for a more proactive approach to treating patients.
Lead author of the review Dr Belinda Jackson, a gastroenterologist at Melbourne’s Austin Hospital, said it confirmed that the average cost of care for Crohn’s disease was about three times that of ulcerative colitis ($15,647 v $5,016) in 2014-15, partly due to a higher need for surgery and hospitalisations.
“This tells us to be more proactive in their care and try to reduce these surgeries and hospitalisations via optimal management,” she told the limbic.
Not surprisingly, it cost less to manage patients in remission than in active disease ($2090 v $3461).
“So we go for a top-down approach now – we go hard with treatment to ensure mucosal healing so patients achieve not just clinical remission but endoscopic remission.”
“For example, we use biologics to get the disease under control as soon as a patient qualifies for their use rather than a watch and wait approach.”
She said the high costs of biologics could not be avoided given the benefits in terms of objective measures – reducing disease activity and preventing complications – but also in terms of patient reported outcomes.
But there was also room to make significant savings in outpatient care.
“One way to improve the current situation in terms of costs and care is to implement some remote management, where possible, for example in patients with mild disease.”
She said online tools to assist with remote management of patients had been shown overseas to reduce clinic numbers by about 20% – freeing up resources to better manage patients with more complicated needs.
A randomised controlled trial of remote management for IBD is anticipated to start at the Austin Hospital later this year.