Length of Hospital Stay, Need for Colectomy Drive Higher Healthcare Costs Associated with Acute Severe Ulcerative Colitis

About 20% to 30% of patients with ulcerative colitis will experience acute severe ulcerative colitis (ASUC) in their lifetime. ASUC is a life-threatening medical emergency characterized by the passage of six or more bloody stools daily, tachycardia, and fever (Truelove Witts criteria).

Standard of care consists of hospitalization for intravenous (IV) corticosteroid treatment and salvage therapy with infliximab (Remicade and several biosimilars) or cyclosporin if there is no improvement after three to five days. Colectomy is indicated in refractory cases or when there is evidence of toxicity or intestinal perforation.

Healthcare costs associated with ASUC are high, and there is a dearth of research identifying factors driving ASUC treatment costs. In a study published last month in JGH Open (a part of the Journal of Gastroenterology and Hepatology), Robert Gilmore, M.B.Ch.B., and his colleagues from the Department of Gastroenterology at Melbourne University sought to characterize the healthcare costs associated with ASUC, investigate factors driving these costs over 12 months following hospital admission, and explore steroid use over this time period.

The team conducted a retrospective review of cost data of patients admitted to a tertiary inflammatory bowel disease center in Melbourne, Australia with ASUC between January 2016 and January 2021. Seventy-two patients were included in the study. All received 100 mg of IV hydrocortisone every 6 hours upon admission.

Of these, 47% did not respond to corticosteroid treatment after three days and received salvage therapy with infliximab. Of the patients who received infliximab, 65% remained on infliximab maintenance therapy after induction. Colectomies were required for 6% of patients during admission and for another 8% during the following 12 months.

The median duration of hospital stay was six days. The median cost of hospital admission was about $5,041*, and the median total healthcare cost over the first 12 months after admission was approximately $8.900*.

Upon data analysis, Gilmore and his team found that the costs of both the initial hospital admission and treatment during the following 12 months were significantly associated with the length of hospital stay and the need for colectomy. Additionally, they found that corticosteroid use was high and led to an increased need for infliximab salvage therapy.

The authors recommend further research to reduce corticosteroid exposure and length of hospitalization for patients with ASUC. They wrote, “…strategies to reduce the duration of initial hospitalization may reduce the healthcare burden associated with ASUC.”

Gilmore and his colleagues further concluded, “Early initiation of medical salvage, as well as novel options for salvage therapy, are avenues for further research on feasibility, safety, and efficacy.”

Editor's Note: Figures were converted from Australian dollars using current currency conversions as of August 2023.