Research Article
Volume 8 Issue 2 - 2021
Study of the Annual Costs Associated with the Treatment of Complex Refractory Perianal Fistulas in Patients with Crohn’s Disease
Martín-Arranz1*, I Pascual Migueláñez2 and JL Marijuán2
1Gastroenterology Department, Innate Immunity Group, IdiPAZ Institute for Health Research, Associate professor of Medicine in UAM. La Paz Hospital, Madrid, Spain
2General Surgery Department, HU. La Paz, Madrid, Spain
*Corresponding Author: Martín-Arranz, Gastroenterology Deparment, Innate Immunity Group, IdiPAZ Institute for Health Research, Associate professor of Medicine in UAM. La Paz Hospital, Madrid, Spain.
Received: December 03, 2020; Published: January 20, 2021


The objective of this study is to quantify the economic impact of the treatment of Complex Perianal Fistulas (CPF) refractory to prior surgical or biological treatment in adult patients with Crohn's Disease (CD). After analysing the patient care pathway and the different treatment alternatives available, an economic model has been developed to allow for the cost estimation of the current approach to the treatment of refractory CPF in CD. In addition to the costs of each therapeutic approach, this model takes into account costs associated to disease recurrence, primary side-effects, and the impact of the disease on labour. Results of this model indicate that the estimated direct annual cost for the treatment of refractory CPF in CD is, at least, €15,241 per patient, amounting to € 21,253,374 for the total population in Spain, with an estimation of 1,395 patients. Regarding indirect costs, the impact on labour of the interventions, measured as the losses incurred as a consequence of sick leaves is estimated to be of at least €186,266 per year for the estimated population. Work absenteeism is estimated to amount to between 10 and 30 days for almost 70% of patients, incurring a total estimated annual cost of €804,599.

Keywords: Perianal Crohn´s Disease; Complex Fistulas; Costs; Healthcare Resources


  1. Sandborn WJ., et al. “AGA technical review on Perianal Crohn’s disease”. Gastroenterology5 (2003): 1508-1530.
  2. Spanish Epidemiological and Economic Study Group on Crohn’s disease. “Epidemiological and clinical features of Spanish patients with Crohn’s disease”. European Journal of Gastroenterology and Hepatology 10 (1999): 1121-1127.
  3. Chaparro M., et al. “Epidemiological study of perianal fistulas in patients with Crohn’s disease”. Gastroenterology 140 (2011): S736.
  4. Göttgens KWA., et al. “Time trends in the epidemiology and outcome of perianal fistulizing Crohn’s disease in a population-based cohort”. European Journal of Gastroenterology and Hepatology 5 (2017): 595-601.
  5. Georgiadou E., et al. “Perianal fistulas in adult patients with Crohn’s disease in Germany - a retrospective cross-sectional analysis of claims data from German sickness funds”. Z Gastroenterology5 (2019): 574-583.
  6. Bermejo F., et al. “Pharmacological Approach to the Management of Crohn’s Disease Patients with Perianal Disease”. Drugs1 (2018): 1-18.
  7. Molodecky NA., et al. “Increasing Incidence and Prevalence of the Inflammatory Bowel Diseases With Time, Based on Systematic Review”. Gastroenterology1 (2012): 46-54.
  8. Lewis RT and Maron DJ. “Efficacy and complications of surgery for Crohn’s disease”. Gastroenterology Hepatology 9 (2010): 587-596.
  9. Kotze PG., et al. “Modern management of perianal fistulas in Crohn’s disease: future directions”. Gut 6 (2018): 1181-1194.
  10. Aguilera-Castro L., et al. “Management of complex perianal Crohn’s disease”. Annals of Gastroenterology 1 (2016): 1-12.
  11. Chaparro M., et al. “Health care costs of complex perianal fistula in Crohn’s disease”. Digestive Diseases and Sciences 12 (2013): 3400-3406.
  12. Ruffolo C., et al. “Perianal Crohn’s disease: Is there something new?” World Journal of Gastroenterology 15 (2011): 1939-1946.
  13. De la Coba Ortiz C and Saro Gismera C. “Incidencia y prevalencia. Epidemiología, Herencia Y Factores De Riesgo.
  14. Lucendo AJ., et al. “Epidemiology and temporal trends (2000-2012) of inflammatory bowel disease in adult patients in a central region of Spain”. European Journal of Gastroenterology and Hepatology (2014): 1.
  15. Panés J., et al. “Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised, double-blind controlled trial”. Lancet100541 (2016): 1281-1290.
  16. Bemelman WA., et al. “ECCO-ESCP Consensus on Surgery for Crohn’s Disease”. Journal of Crohn's and Colitis (2017).
  17. Bell SJ., et al. “The clinical course of fistulating Crohn’s disease”. Alimentary Pharmacology and Therapeutics9 (2003): 1145-1151.
  18. Chaparro M., et al. “Intensificación” del Tratamiento con Infliximab (Ifx) En La Enfermedad De Crohn: Eficacia y Seguridad”. Gastroenterology Hepatology3 (2009): 218.
  19. Adegbola SO., et al. “Medical and surgical management of perianal crohn’s disease”. Annals of Gastroenterology2 (2018): 129-139.
  20. Muñoz-Duyos A., et al. “Clinical and cost effectiveness of sacral nerve stimulation for faecal incontinence”. British Journal of Surgery8 (2008): 1037-1043.
  21. Bochenska K and Boller A. “Fecal Incontinence: Epidemiology, Impact, and Treatment” Clin Colon Rectal Surg 212 (2016): 264-270.
  22. Kelley KA., et al. “Perianal Crohn’s disease: challenges and solutions”. Clinical and Experimental Gastroenterology 10 (2017): 39-46.
  23. Owen H., et al. “Quality of life with anal fistula”. Annals of the Royal College of Surgeons of England5 (2016): 334-338.
  24. Abbas MA., et al. “Predictors of Outcome for Anal Fistula Surgery”. JAMA Surgery9 (2011): 1011-1016.
  25. Bubbers EJ and Cologne KG. “Management of Complex Anal Fistulas”. Clinics in Colon and Rectal Surgery1 (2016): 43-49.
  26. Cirocchi R., et al. “Fibrin glue in the treatment of anal fistula: A systematic review”. Annals of Surgical Innovation and Research 3 (2009): 1-7.
  27. Hammond TM., et al. “Fibrin glue in the management of complex anal fistula”. Arq Gastroenterol4 (2009): 300-303.
  28. Klag T., et al. “Medical Therapy of Perianal Crohn’s Disease”. Visz Gastrointest Med Surg4 (2015): 265-272.
  29. Nielsen OH., et al. “Diagnosis and management of fistulizing Crohn’s disease”. Nat Clin Pract Gastroenterol Hepatol2 (2009): 92-106.
  30. D’Haens G., et al. “Five-year Safety Data From ENCORE, a European Observational Safety Registry for Adults With Crohn’s Disease Treated With Infliximab [Remicade ®] or Conventional Therapy”. Journal of Crohn’s and Colitis6 (2017): 680-689.
  31. Senéjoux A., et al. “Fistula Plug in Fistulising Ano-Perineal Crohn’s Disease: a Randomised Controlled Trial”. Journal of Crohn’s and Colitis2 (2016): 141-148.
  32. Panés J., et al. “Long-term Efficacy and Safety of Stem Cell Therapy (Cx601) for Complex Perianal Fistulas in Patients With Crohn’s Disease”. Gastroenterology5 (2018): 1334-1342.
  33. Sands BE., et al. “Infliximab Maintenance Therapy for Fistulizing Crohn’s Disease”. The New England Journal of Medicine9 (2004): 876-885.
  34. Vollebregt PF., et al. “Impacts of perianal disease and faecal incontinence on quality of life and employment in 1092 patients with inflammatory bowel disease”. Alimentary Pharmacology and Therapeutics9 (2018): 1253-1260.
  35. Lönnfors S., et al. “IBD and health-related quality of life - Discovering the true impact”. Journal of Crohn’s and Colitis10 (2014): 1281-1286.
  36. World Health Organization. Country-specific inpatient and outpatient estimates in 2010 currency (2010).
  37. Duff S., et al. “Infliximab and surgical treatment of complex anal Crohn's disease”. Colorectal Disease8 (2012): 972-976.
  38. Lewis RT and Maron DJ. “Anorectal Crohn’s disease”. Surgical Clinics of North America1 (2010): 83-97.
  39. Mahadev S., et al. “Self-reported depressive symptoms and suicidal feelings in perianal Crohn's disease”. Colorectal Disease3 (2012): 331-335.
  40. Longworth L., et al. “Patient” 12.3 (2019): 339-348.
Citation: Martín-Arranz., et al. “Study of the Annual Costs Associated with the Treatment of Complex Refractory Perianal Fistulas in Patients with Crohn’s Disease”. EC Gastroenterology and Digestive System 8.2 (2021): 44-53.

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