P606 Health-related utility weights in Crohn's disease patients with perianal fistula. (16th January 2018)

• Record Type: Journal Article
• Authors: Longworth, L; Fountain, D; Singh, J; Azzabi, I; Owen, G
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S415
• Page End: S416
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.733
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Perianal fistulae are a common complication of Crohn's disease (CD) and impose a substantial quality of life burden. Data capturing health-related utility associated with perianal fistula in CD are scarce, where utility is defined on a scale of 1 (full health) and 0 (dead). The study aim was to value health states related to different stages of the disease, including last-resort major surgeries, to quantitatively evaluate the humanistic burden of perianal fistula in CD. Methods: Eight health state descriptions associated with complex perianal fistula in CD were developed following qualitative research with patients and validated by clinicians. Following pre-testing, a survey was administered online in two samples of UK respondents: general population and patients with CD. A choice based valuation technique, the time trade-off (TTO) was used to elicit utility values. CD patients also valued their current heath state using the TTO. Exclusion criteria for respondents displaying logical inconsistencies were applied. Results: 1040 respondents completed the general population survey, and were reflective of the UK population in age and gender. The patient survey was completed by 201 CD patients. Of these, 33% had experienced perianal fistula, 36% perianal abscess, 27% abdominal abscess and 47% had undergone surgery for CD. Responses to the TTO questions were converted into utility values (Table 1). In both samples, the Remission state of non-active perianal CD was valued highest. Defunctioning (colostomy or ileostomy) and proctectomy surgery with negative outcomes had the lowest utility values. Patients currently experiencing fistula reported lower values for current health than those without fistula. Conclusions: To our knowledge, this is the largest utility study in CD patients with perianal fistula. Patients reported slightly higher values than the general population for some states; however, the surveys produced broadly similar values, providing evidence that the estimates are not subject to significant random error. Most health states were attributed low utility values by both the general public and CD patients. Non-remission states were valued much lower than the remission state: ranging from 0.20 for proctectomy with negative outcome to 0.66 for chronic symptomatic fistulae with mild symptoms. This demonstrates the high humanistic burden of perianal fistula in CD.