Impact of Crohn’s perianal fistulas on healthcare resource utilization: a US chart review study

Aim: Perianal fistulas are a common complication of Crohn’s disease. Despite the current treatment options, fistula recurrence/treatment failure rates are high. The aim of this study was to assess healthcare resource utilization (HCRU) among patients with new, persistent, and recurrent Crohn’s perianal fistulas (CPF) in the USA. Method: A retrospective, multi-site medical chart review was conducted in patients with CPF. Data on HCRU were collected for ≥2 years after the index date (date of most-recent episode of CPF symptoms between January 2016 and December 2018). Results: In total, 227 patients were included among whom there were 236 fistulas: new (n = 94, 39.8%), persistent (n = 108, 45.8%), and recurrent (n = 34, 14.4%). Mean (standard deviation [SD]) age was 47.7 (13.7) years, 81.5% were White, 50.7% were male. After index (mean follow-up 33.8 months), 67.0% of patients received medical treatments, 59.9% had surgical interventions, and 42.7% received both. The mean (SD) number of CPF-related and all-cause outpatient visits was 8.75 (8.20) and 18.27 (16.96), the mean (SD) number of CPF-related and all-cause emergency room visits was 0.06 (0.27) and 0.65 (1.55), and the mean (SD) number of CPF-related and all-cause inpatient visits was 0.30 (0.79) and 0.83 (1.81), respectively. Patients with new fistulas had more CPF-related and all-cause outpatient visits and fewer all-cause inpatient visits than patients with persistent/recurrent fistulas (p < 0.05). Limitations: The use of biologics for underlying Crohn’s disease before index was not captured. Furthermore, this study was subject to missing data and limited generalizability (most sites located in Midwest USA). Conclusion: There is a substantial HCRU burden among patients with CPF, likely owing to the requirement for multiple and repeated interventions, indicating an unmet need for effective management strategies that promote long-term fistula healing to ultimately support reduced patient burden and HCRU.