Intravenous cyclosporine for the treatment of severe steroid refractory ulcerative colitis: What is the cost?

Lisa Poritz, William A. Rowe, Brian R. Swenson, Christopher S. Hollenbeak, Walter Koltun

Research output: Contribution to journalReview article

23 Scopus citations

Abstract

PURPOSE: Intravenous cyclosporine often is used to treat patients with severe steroid refractory colitis secondary to ulcerative colitis in an attempt to avoid urgent total abdominal colectomy. The purpose of this study was to evaluate the success and cost of cyclosporine. METHODS: A retrospective, chart review of all patients from 1996 to 2002 who were treated with cyclosporine and/or had a three-stage ileal pouch-anal anastomosis for severe steroid refractory colitis at our institution was performed. Patients were divided into three groups: TAC and CyA: patients who failed cyclosporine and had urgent total abdominal colectomy on the same admission; TAC no CyA: patients who had an urgent total abdominal colectomy without cyclosporine; and CyA only: patients treated successfully with cyclosporine and discharged without surgery. A subgroup of patients who had an ileal pouch-anal anastomosis was identified from each group. Cost data were obtained from the hospital's financial records. RESULTS: Forty-one patients (25 males) were identified. Twenty-nine patients received cyclosporine for severe steroid refractory colitis. Of these, 18 (62 percent) failed and underwent total abdominal colectomy on the same admission. Eleven (38 percent) responded to the cyclosporine and were discharged. Of the 11, 4 never had surgery, 1 had a three-stage ileal pouch-anal anastomosis, 5 had a two-stage ileal pouch-anal anastomosis, and 1 had a total abdominal colectomy only. Only 14 percent of patients avoided colectomy in the long-term. Complications of cyclosporine occurred in 8 patients (28 percent), and surgical complications occurred in 12 patients. CONCLUSIONS: The highest costs, highest length of stay, and highest number of overall complications were found in the group of patients who failed intravenous cyclosporine and required colectomy during the same hospitalization.

Original languageEnglish (US)
Pages (from-to)1685-1690
Number of pages6
JournalDiseases of the colon and rectum
Volume48
Issue number9
DOIs
StatePublished - Sep 1 2005

    Fingerprint

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this