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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.


Selwyn ODES, (Professor of Gastroenterology)
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