THE OUTPATIENT BURDEN OF IBD: A 10 YEAR REVIEW

M. W. Johnson, K. Lithgo, T. Prouse, T. Price

Gastroenterology Department, Luton & Dunstable University Hospital, Luton. LU40DZ. UK.

Introduction

In an attempt to acquire appropriate funding from our Clinical Commissioning Group (CCG) for our inflammatory bowel disease (IBD) service, we wanted to establish the total cost of managing IBD patients through our local hospital NHS outpatient system.

The Luton & Dunstable University Hospital has a database of 2680 local IBD patients. This is made up of 1425 patients with UC, 941 with Crohn’s, 118 with proctitis, 113 with IBD unspecified, 53 with radiation proctitis, 13 with diversion colitis, 10 with ileo-anal pouchitis and 7 with microscopic colitis. Over the preceding 5 years, 350 of them had been transferred to community based patient self management programmes (PSMPs).

Aims

1) To establish the average number of OPAs per patients per year.2) To assess the cost to the CCGs of this IBD outpatient demand.3) To review which specialty these patients were being reviewed by,

Methods 1

Using the IBD database the hospital coding system was used to analyse the total number of outpatient appointments (OPAs) made between 2001 and 2011 for these patients, and to which specialties they were referred. Total costs were calculated using a range of prices for the different specialties, depending on whether they were new (£210-£265) or follow up clinic visits (£83-£136).

Results

Over the course of 10 years our cohort of 2680 IBD patients had made 20,837 gastroenterology OPAs (2,053 new and 18,784 follow ups) ie. 2,084 per year, costing our local Clinical Commissioning Group (CCG) a total of £2,103,117. There were also 3474 OPAs made with the gastrointestinal (GI) surgeons (1,409 new and 2,065 follow ups) (ie. 347 per year), costing the localPCT a total of £603,524. In addition a further 42,276 (63%) OPAs were made with non-GI teams, costing the PCT a further £4,227,600.

Results 2

Conclusions

Over 10 years the 2680 patients made a total of 66,007 outpatient clinic visits (2.46 per person per year) costings a total of £6,934,241. Of these, 24,311 (37%) were with a medical gastroenterologist or gastrointestinal surgeon, costing the local CCG atotal of £2,706,641 (£270,664 per year).

Many of the non-GI specialty appointments were made for IBD associated conditions eg. 1510 dermatology OPAs. The 921 diabetic and 3281 ophthalmology OPAs (predominantly for cataracts), raise concerns about potential iatrogenic steroid induced complications.

Gastro Hepatology Gen Medicine Surgery

New £ 265 £ 224 £ 210 £ 251

Follow Up £ 83 £ 136 £ 105 £ 121

MedicineMedicine SurgerySurgery

NewNew £ 544,045£ 544,045 £ 353,659£ 353,659

Follow UpFollow Up £1,559,072£1,559,072 £ 249,865£ 249,865

Table 1. CCG Outpatient Clinic Tariffs

Table 2. 10 year costs of IBD on the outpatient service

Table 3. Number of OPAs per specialty over 10 years

Specialty No. of OPAsGastroenterology 19309General Medicine 10438General Surgery 4422

Cardiology 4343Ophthalmology 3281

Trauma 2985Dermatology 1510

Care of the Elderly 1359Urology 1309

Gynaecology 1299Plastic Surgery 1267

Medical Oncology 1106Colorectal Cancer 1036

Oral Surgery 981Haematology 956Respiratory 939Obstetrics 931Diabetes 921

Orthopaedics 862Neurology 816Paediatrics 755

Hearing Aids 664Cardiac Rehab 559