Iron deficiency anemia impacts disease progression and healthcare resource consumption in patients with inflammatory bowel disease: a real-world evidence study

Gionata Fiorino; Jean-Frederic Colombel; Kostas Katsanos; Fermín Mearin; Jürgen Stein; Margherita Andretta; Stefania Antonacci; Loredana Arenare; Rita Citraro; Stefania Dell'Orco; Luca Degli Esposti; Antonio Ramirez de Arellano Serna; Neige Morin; Ioannis E Koutroubakis

doi:10.1177/17562848231177153

Iron deficiency anemia impacts disease progression and healthcare resource consumption in patients with inflammatory bowel disease: a real-world evidence study

Therap Adv Gastroenterol. 2023 May 30:16:17562848231177153. doi: 10.1177/17562848231177153. eCollection 2023.

Authors

Affiliations

¹ Gastroenterology and Digestive Endoscopy, Vita-Salute San Raffaele University, Milan, Italy.
² Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy.
³ Mount Sinai, New York, NY, USA.
⁴ University of Ioannina, Ioannina, Greece.
⁵ Teknon Medical Center, Barcelona, Spain.
⁶ DGD Kliniken Frankfurt Sachsenhausen, Frankfurt/Main, Germany.
⁷ Azienda ULSS 8 Berica, Vicenza, Italy.
⁸ ASL Bari, Bari, Italy.
⁹ Asl Latina, Latina, Italy.
¹⁰ Azienda Ospedaliero-Universitaria Mater Domini, Catanzaro, Italy.
¹¹ ASL Roma 6, Albano Laziale, Italy.
¹² CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy.
¹³ CSL Vifor, Glattbrugg, Zürich, Switzerland.
¹⁴ Department of Gastroenterology, University Hospital Heraklion, P.O. BOX 1352, Heraklion, Crete 71110, Greece.

Abstract

Background: Iron deficiency anemia (IDA) is a common extraintestinal manifestation of inflammatory bowel disease (IBD), affecting around one-third of patients.

Objective: To compare IBD progression and healthcare resource utilization in patients with and without a co-diagnosis of IDA in a real-world setting.

Design: A retrospective comparative study was conducted using Italian entities' administrative databases, covering 9.3 million health-assisted individuals.

Methods: Adult IBD patients diagnosed with ulcerative colitis and/or Crohn's disease were enrolled between January 2010 and September 2017. Within 12 months from IBD diagnosis, IDA was identified by at least one prescription for iron and/or IDA hospitalization and/or blood transfusion (proxy of diagnosis). IBD population was divided according to the presence/absence of IDA. Given the nonrandom patients' allocation, propensity score matching (PSM) was applied to abate potential unbalances between the groups. Before and after PSM, IBD progression (in terms of IBD-related hospitalizations and surgeries), and healthcare resource costs were assessed.

Results: Overall, 13,475 IBD patients were included, with an average age at diagnosis of 49.9 years, and a 53.9% percentage of male gender. Before PSM, 1753 (13%) patients were IBD-IDA, and 11,722 (87%) were IBD-non-IDA. Post-PSM, 1753 IBD-IDA patients were matched with 3506 IBD-non-IDA. Before PSM, IBD progression was significantly higher in IBD-IDA (12.8%) than in IBD-non-IDA (6.5%) (p < 0.001). After PSM, IBD progression and IBD-related hospitalizations were significantly (p < 0.001) more frequent in IBD-IDA patients (12.8% and 12.0%, respectively) compared to IBD-non-IDA (8.7% and 7.7%). Consistently, healthcare expenditures resulted significantly higher among IDA patients (p < 0.001), with an overall mean annual cost of €5317 compared to €2798 for patients without IDA. These results were confirmed after PSM matching, as the mean annual total cost/patient in IBD-IDA versus IBD-non-IDA were €3693 and €3046, respectively (p < 0.001).

Conclusion: In a real-life setting, IDA co-diagnosis in IBD patients was associated with disease progression and higher related economic burden.

Keywords: Crohn’s disease; disease progression; healthcare cost analysis; inflammatory bowel disease; iron deficiency anemia; real-world evidence; ulcerative colitis.