O5-17. Biologic therapy and surgery in inflammatory bowel disease: Regional differences in Norway

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Sandre Svatun Lirhus [1], Hans Olav Melberg [1], Marte Lie Høivik [2], Bjørn Moum [1,2]
Affiliates: [1] University of Oslo, [2] Oslo University Hospital

Background
Treatment of IBD patients can be classified as ‘preference sensitive care’ since more than one accepted approach is available, such as elective surgery and medical therapy for patients with moderate to severe IBD. With preference sensitive care, treatment rates may vary extensively because of differences in professional opinion.
The aim of this study was to describe the use of biologic therapy and surgery in treatment of IBD patients in the four health regions in Norway.

Methods
Data was collected from the Norwegian Patient Registry and included information on every individual hospital treatment episode for IBD patients (ICD codes K50 and K51) from 2008 to 2015. In order to reduce the number of prevalent cases, the results were calculated for patients who were first observed between 2010 and 2012. The patients first observed in 2013-2015 were excluded since they had too short follow-up.
The patients were followed for three years after their first observed IBD diagnosis. Only patients with at least two IBD related hospital events were included.

Results
After three years, the percentage of patients with Crohn’s disease (CD) who had received surgery ranged from 11.4% to 17.1% between the four health regions. For patients with ulcerative colitis (UC), the percentages ranged from 4.6% to 6.9%.
After three years, the proportion of CD (UC) patients who had received biologics ranged from 20.9% to 31.5% (8% to 13.5%).

Conclusions
There are large differences in the use of biologic therapy and surgery for IBD patients across Norway’s health regions, which may lead to unintended differences in health care outcomes and costs.