USING REAL-WOLRD HEALTHCARE DATA TO DEFINE AND PREVENT COMPLICATIONS IN INFLAMMATORY BOWEL DISEASEAnderson, Alyce (2017) USING REAL-WOLRD HEALTHCARE DATA TO DEFINE AND PREVENT COMPLICATIONS IN INFLAMMATORY BOWEL DISEASE. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractInflammatory bowel disease (IBD) is a collection of chronic, immune mediated disorders of the gastrointestinal track, characterized by relapsing and remitting disease activity. Despite our growing understanding of risk factors associated with developing disease, we still lack understanding of the impact of disease complications and how to best avoid complications with preventive care. Two known complications of IBD include the increased predisposition to Clostridium difficile infection and the increased risk of non-melanoma and melanoma skin cancers. This thesis aims to (1) define the long-term impact of Clostridium difficile infection on IBD patients after accounting for patients’ inherent risk of infection, (2) evaluate the rate at which IBD patients access dermatologic preventive care for skin cancer screening, and (3) model the cost-effectiveness of melanoma screening strategies in the IBD patient population. We found that Clostridium difficile infection was significantly associated with more steroid and antibiotic exposure, elevated inflammatory markers, increased disease activity, worse quality of life, and increased healthcare utilization in the year of infection. During the year after infection, patients in the Clostridium difficile group continued to have increased exposure to Clostridium difficile targeted antibiotics and other systemic antibiotics, while having more clinic visits, telephone encounters, and a five-fold increase in healthcare charges. We determined that 21% of IBD patients utilized dermatology from 2010-2016, and 2.6% of patients had at least one total body exam for skin cancer screening. Between 8% and 11% of patients recommended by gastroenterology preventive care guidelines visited dermatology each year, suggesting only a small proportion of IBD patients recommended for screening obtain dermatologic care. Finally, we used a Markov model to estimate intervention costs and effectiveness of melanoma screening in the IBD population. We found screening for melanoma in IBD patients was more effective, but expensive. Among model variations, screening every other year was the most cost-effective strategy. In conclusion, the dissertation reveals the long-term impact of infection among IBD patients, the underutilization of dermatologic preventive care, and provides a cost effectiveness model to inform the development of skin cancer screening programs in IBD. Share
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