{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:21:11Z","timestamp":1789651271277,"version":"4.0.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T00:00:00Z","timestamp":1631664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perianal fistula (PAF), a complication of Crohn\u2019s disease (CD), is associated with substantial economic costs and poor prognosis. We determined prevalence of PAF CD in the United States and compared costs and health care resource utilization (HRU) of PAF CD patients with matched non-PAF CD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study of claims data from the IBM MarketScan Commercial Database from October 1, 2015, to September 30, 2018. Eligible patients were aged 18 to 89 years with \u22652 CD diagnoses. Patients with PAF CD had \u22651 PAF diagnosis or procedure code and were matched with non-PAF CD patients. Cumulative prevalence of PAF CD in the US population was calculated across total patients in MarketScan. All-cause and gastrointestinal (GI)-related costs and HRU were compared between groups using a generalized linear model (GLM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cumulative 3-year prevalence of PAF was 7.70% of patients with CD (N\u2005=\u200581,862) and 0.01% of the US population. Among PAF CD (n\u2005=\u20051218) and matched non-PAF CD (n\u2005=\u20054095) patients, most all-cause costs and HRU were GI-related. Mean total all-cause and GI-related health care costs per patient and per year for PAF CD were $85,233 and $71,612, respectively, vs $40,526 and $29,458 for non-PAF CD (P\u2005&amp;lt; .0001). Among PAF CD vs non-PAF CD patients, GLM-adjusted proportions of patients with GI-related inpatient, outpatient, or pharmacy visits, mean GI-related inpatient length of stay, and mean GI-related surgeries were higher (P\u2005&amp;lt; .0001 for all comparisons).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Costs and HRU are significantly higher for patients with PAF CD vs non-PAF CD patients, highlighting the economic burden of the disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ibd\/izab198","type":"journal-article","created":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T13:42:33Z","timestamp":1631713353000},"page":"870-877","source":"Crossref","is-referenced-by-count":27,"title":["Health Care Costs and Resource Utilization Among Patients With Crohn\u2019s Disease With and Without Perianal Fistula"],"prefix":"10.1093","volume":"28","author":[{"given":"Grace","family":"Chen","sequence":"first","affiliation":[{"name":"Takeda Pharmaceuticals U.S.A., Inc. , Lexington , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasantha","family":"Pedarla","sequence":"additional","affiliation":[{"name":"STATinMED Research , Plano, TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle D","family":"Null","sequence":"additional","affiliation":[{"name":"Takeda Pharmaceuticals U.S.A., Inc. , Lexington , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E","family":"Cazzetta","sequence":"additional","affiliation":[{"name":"Takeda Pharmaceuticals U.S.A., Inc. , Lexington , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qasim Rana","family":"Khan","sequence":"additional","affiliation":[{"name":"Takeda Pharmaceuticals U.S.A., Inc. , Lexington , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7026-7099","authenticated-orcid":false,"given":"David A","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center , Nashville , TN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,9,15]]},"reference":[{"key":"2023112217574791100_CIT0001","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1016\/S0140-6736(12)60026-9","article-title":"Crohn\u2019s disease","volume":"380","author":"Baumgart","year":"2012","journal-title":"Lancet."},{"key":"2023112217574791100_CIT0002","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1002\/ibd.20530","article-title":"Effects of fistula on health care costs and utilization for patients with Crohn\u2019s disease treated in a managed care environment","volume":"14","author":"Cohen","year":"2008","journal-title":"Inflamm Bowel Dis."},{"key":"2023112217574791100_CIT0003","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.15585\/mmwr.mm6542a3","article-title":"Prevalence of inflammatory bowel disease among adults aged \u226518 years - United States, 2015","volume":"65","author":"Dahlhamer","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"2023112217574791100_CIT0004","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1053\/j.gastro.2011.10.001","article-title":"Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review","volume":"142","author":"Molodecky","year":"2012","journal-title":"Gastroenterology."},{"key":"2023112217574791100_CIT0005","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.cgh.2016.10.039","article-title":"Incidence and prevalence of Crohn\u2019s disease and ulcerative colitis in Olmsted County, Minnesota, from 1970 through 2010","volume":"15","author":"Shivashankar","year":"2017","journal-title":"Clin Gastroenterol Hepatol."},{"key":"2023112217574791100_CIT0006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ibd\/izy247","article-title":"Clinical practice guideline for the medical management of perianal fistulizing Crohn\u2019s disease: the Toronto Consensus","volume":"25","author":"Steinhart","year":"2019","journal-title":"Inflamm Bowel Dis."},{"key":"2023112217574791100_CIT0007","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1093\/ibd\/izz056","article-title":"Prevalence of fistulizing crohn\u2019s disease in the United States: estimate from a systematic literature review attempt and population-based database analysis","volume":"25","author":"Schwartz","year":"2019","journal-title":"Inflamm Bowel Dis."},{"key":"2023112217574791100_CIT0008","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2147\/CEG.S108513","article-title":"Perianal Crohn\u2019s disease: challenges and solutions","volume":"10","author":"Kelley","year":"2017","journal-title":"Clin Exp Gastroenterol."},{"key":"2023112217574791100_CIT0009","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1053\/gast.2002.32362","article-title":"The natural history of fistulizing Crohn\u2019s disease in Olmsted County, Minnesota","volume":"122","author":"Schwartz","year":"2002","journal-title":"Gastroenterology."},{"key":"2023112217574791100_CIT0010","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/MEG.0000000000000840","article-title":"Time trends in the epidemiology and outcome of perianal fistulizing Crohn\u2019s disease in a population-based cohort","volume":"29","author":"G\u00f6ttgens","year":"2017","journal-title":"Eur J Gastroenterol Hepatol."},{"key":"2023112217574791100_CIT0011","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/DCR.0b013e3182099d9e","article-title":"Quality of life in perianal Crohn\u2019s disease: what do patients consider important?","volume":"54","author":"Mahadev","year":"2011","journal-title":"Dis Colon Rectum."},{"key":"2023112217574791100_CIT0012","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1111\/apt.14599","article-title":"Impacts of perianal disease and faecal incontinence on quality of life and employment in 1092 patients with inflammatory bowel disease","volume":"47","author":"Vollebregt","year":"2018","journal-title":"Aliment Pharmacol Ther."},{"key":"2023112217574791100_CIT0013","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1038\/ajg.2018.27","article-title":"ACG clinical guideline: management of crohn\u2019s disease in adults","volume":"113","author":"Lichtenstein","year":"2018","journal-title":"Am J Gastroenterol."},{"key":"2023112217574791100_CIT0014","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/ecco-jcc\/jjz187","article-title":"ECCO guidelines on therapeutics in crohn\u2019s disease: surgical treatment","volume":"14","author":"Adamina","year":"2020","journal-title":"J Crohns Colitis."},{"key":"2023112217574791100_CIT0015","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/ecco-jcc\/jjz180","article-title":"ECCO guidelines on therapeutics in crohn\u2019s disease: medical treatment","volume":"14","author":"Torres","year":"2020","journal-title":"J Crohns Colitis."},{"key":"2023112217574791100_CIT0016","doi-asserted-by":"crossref","first-page":"4821","DOI":"10.3748\/wjg.v24.i42.4821","article-title":"Burden and outcomes for complex perianal fistulas in Crohn\u2019s disease: systematic review","volume":"24","author":"Panes","year":"2018","journal-title":"World J Gastroenterol."},{"key":"2023112217574791100_CIT0017","doi-asserted-by":"crossref","first-page":"3400","DOI":"10.1007\/s10620-013-2830-7","article-title":"Health care costs of complex perianal fistula in Crohn\u2019s disease","volume":"58","author":"Chaparro","year":"2013","journal-title":"Dig Dis Sci."},{"key":"2023112217574791100_CIT0018","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1093\/ibd\/izz100","article-title":"Opioid use is associated with higher health care costs and emergency encounters in inflammatory bowel disease","volume":"25","author":"Alley","year":"2019","journal-title":"Inflamm Bowel Dis."},{"key":"2023112217574791100_CIT0019","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jss.2018.04.005","article-title":"Patterns of opioid use and prescribing for outpatient anorectal operations","volume":"229","author":"Swarup","year":"2018","journal-title":"J Surg Res."},{"key":"2023112217574791100_CIT0020","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1093\/ibd\/izy329","article-title":"Update on the natural course of fistulizing perianal crohn\u2019s disease in a population-based cohort","volume":"25","author":"Park","year":"2019","journal-title":"Inflamm Bowel Dis."},{"key":"2023112217574791100_CIT0021","first-page":"11","article-title":"The cost of paediatric and perianal Crohn\u2019s disease in Canterbury, New Zealand","volume":"125","author":"Lion","year":"2012","journal-title":"N Z Med J."},{"key":"2023112217574791100_CIT0022","doi-asserted-by":"crossref","first-page":"496","DOI":"10.5217\/ir.2019.00050","article-title":"Polypharmacy is a risk factor for disease flare in adult patients with ulcerative colitis: a retrospective cohort study","volume":"17","author":"Wang","year":"2019","journal-title":"Intest Res."}],"container-title":["Inflammatory Bowel 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