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Comparison of Health Care Utilization and Costs Between Patients with Perianal Fistulizing Crohn's Disease Treated with Biologics with or Without Previous Seton Placement

Schwartz, David A. MD*; Wang, Anthony PhD, MPH; Ozbay, Burak PhD; Skup, Martha PhD; Eichner, Samantha F. PharmD; Lin, Jay PhD; Chao, Jingdong PhD

doi: 10.1097/MIB.0000000000001243
Original Clinical Articles

Background: Fistulas are a common and often debilitating complication of Crohn's disease (CD). Tumor necrosis factor inhibitors and/or seton drainage are effective treatment options. We compared health care utilization and costs for patients with perianal CD who had setons placed before treatment with biologics versus those who did not.

Methods: Patients with CD (≥18 yr) were identified from the Truven Health MarketScan Database by ICD-9 code 555.x (January 1, 2006–March 31, 2015); those with external fistulas were identified by ICD-9 codes 565.1. Biological treatment and seton procedures were identified with the National Drug Codes or Current Procedural Terminology codes. Patients were grouped into 2 cohorts: seton before biological (SBB) treatment or no seton before biological (NSBB) treatment.

Results: SBB (N = 326) and NSBB (N = 1519) groups were similar in baseline age, sex, use of immunosuppressants and steroids, and comorbidity score. Baseline prevalence of asthma and cardiovascular disease, and use of antibiotics and 5-aminosalicylic acid were significantly greater in the SBB group versus the NSBB group. Baseline number of all-cause and fistula-related hospitalizations were greater for the SBB group than in the NSBB group. However, during follow-up, the NSBB group required significantly more hospitalizations than the SBB group (all-cause: 0.41 versus 0.23; fistula related: 0.16 versus 0.07) and had significantly greater health care costs (all-cause: $9711 versus $5514; fistula related: $4156 versus $1900). Results were confirmed in multivariate regressions adjusting for baseline characteristics and prescription drug use.

Conclusions: Patients who had the setons placed before treatment with biologics used fewer health care resources and incurred lower health care costs compared with those who did not have the procedure.

Article first published online 29 August 2017.

*Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, Tennessee;

AbbVie Inc., North Chicago, Illinois; and

Novosys Health, Green Brook, New Jersey.

Address correspondence to: David A. Schwartz, MD, Vanderbilt University Medical Center, 211 21st Avenue, Suite 220 MAB, Nashville, TN 37232 (e-mail:

Design, study conduct, and financial support for the study were provided by AbbVie, Inc. AbbVie participated in the interpretation of data, review, and approval of the manuscript. All authors contributed to the development of the publication and maintained control over the final content.

D. A. Schwartz, MD: AbbVie: consultant, grant support; UCB: consultant, grant support; Janssen: Consultant; Takeda: Consultant; Tigenix: Consultant. A. Wang, PhD, MPH: Employee of AbbVie and may own stock or stock options. A. B. Ozbay, PhD: Employee of AbbVie at the time of the study and may own stock or stock options. M. Skup, PhD: Employee of AbbVie and may own stock or stock options. S. F. Eichner, PharmD: Employee of AbbVie and may own stock or stock options. J. Lin, PhD: Consultant of AbbVie. J. Chao, PhD: Employee of AbbVie at the time of the study and may own stock or stock options.

Received February 22, 2017

Accepted June 25, 2017

© Crohn's & Colitis Foundation
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