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ASCA and the NOD2/CARD15 mutation SNP12 predict increased hospitalizations and surgical costs in Crohn's disease patients

Background NOD2/CARD15, a susceptibility gene in Crohn s disease, is associated with ileal involvement, intestinal stenosis and increased frequency of surgery. Anti-Saccharomyces cerevisiae antibody (ASCA), a serological marker for Crohn's disease, is associated with ileal location and a high likelihood for surgery. We hypothesized that the presence of ASCA and NOD2/CARD15 mutations could predict an increased cost of health care in Crohn's disease.

Methods Crohn's disease patients in a prospectively-incepted community-based multinational European cohort had blood drawn for measurement of ASCA (IgG, IgA) and the NOD2/CARD15 mutations SNP8, SNP12 and SNP13. Days spent in hospital, surgical events, and consumption of major drugs (corticosteroids, immunosuppressives, biologicals) and 5-aminosalicylates were calculated. The cost of health care was calculated from use of resources and their median prices.

Findings Patients were followed for mean 8.3 [SD 2.6] years. The mean duration of medical hospitalizations was longer in the SNP12 positive patients than SNP12 negative patients, 6.4 [10.7] versus 2.5 [3.6] days/patient-year (p<0.01). The mean duration of surgical hospitalizations was longer in the SNP12 positive than SNP12 negative patients, 4.2 [3.9] versus 1.5 [2.8] days/patient-year (p<0.01). ASCA positive patients had a longer mean surgical hospitalization time than ASCA negative patients, 2.5 [7.7] and 1.2 [2.4] days/patient-year respectively (p<0.001. Mean medical hospitalization costs were 2380 [3938] /patient-year in SNP12 positive patients and 937 [1340] /patient-year in SNP12 negative patients (p<0.02). Mean surgical hospitalization costs totaled 1781 [1607] /patient-year in SNP12 positive and 664 [1226] /patient-year in SNP12 negative patients (p<0.02). The mean cost of surgical hospitalization was higher in ASCA positive than ASCA negative patients, 1134 [1532] and 542 [1075] /patient-year respectively. Allowance for skewed health care costs and for smoking did not detract from the effect of SNP12 and ASCA on surgical admissions and costs.

Interpretation A positive ASCA test or the presence of the NOD2/CARD15 mutation SNP12 was associated with longer and costlier surgical admissions. Genetic mutations and ASCA seem to be indicative of higher health care costs in Crohn's disease.

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Selwyn ODES, (Professor of Gastroenterology)
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