P1215 Hospital utilisation for ulcerative colitis in Australia, 1993–2022: a review of observational separation data
Authors: Meehan E , Pillay L 
Published: January 2025

Abstract

Background
The prevalence of ulcerative colitis (UC) is compounding in Western nations, including in the Australasia region1. Mortality has fallen over the last 7 decades since the introduction of intravenous corticosteroids, but despite newer therapies, colectomy rates have not improved2, 3. UC is a chronic, relapsing and remitting condition, and flares lead to hospitalisations and significant costs4. In the era of advanced IBD therapies, understanding trends in admissions will guide cost management strategies. We aimed to assess hospital utilisation trends for UC in Australia between 1993-94 and 2021-22.

Methods
We obtained resident population figures from the Australian Bureau of Statistics and hospital data for the financial years 1993-94 and 2021-22 from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database. We calculated the rate of hospital separations due to UC (ICD-10 code K51) per 100,000 residents, mean length of stay, and bed utilisation rate for UC admissions. The advent of biologics between 1993-94 and 2021-22 led to an increase in hospital separations and bed days, as each visit to an infusion unit is treated as a separate same-day hospital separation with a uniform length of stay of 1 day. Therefore, we also assessed the separation rate, mean length of stay, and bed utilisation rate for non-same-day separations (i.e., overnight or multi-day stays) to better reflect trends in acute UC flares requiring emergency treatment.

Results
Total hospital separations for UC grew by 841.1%, from 5,148 in 1993-94, to 48,447 in 2021-22; total patient days increased by 286.1%, from 18,396 to 71,034. Same-day admissions rose 1160.7%, from 3,499 to 44,111. Non-same-day hospitalisations grew by 163.0%, from 1,649 to 4,336, and total days in hospital for these multi-day stays grew by 80.7%, from 14,897 to 26,923. The rate of non-same-day hospitalisation increased by 80.0%, from 9.3 to 16.7 per 100,000 people. Mean length of stay for non-same-day admissions decreased by 31.2%, from 9.0 days to 6.2 days per stay. The bed utilisation rate for UC non-same-day admissions per 100,000 increased by 23.7% from 83.7 to 103.5 per 100,000 people.

Conclusion
Infusion unit visits for new biologics have driven a massive rise in same-day hospital separations with a primary diagnosis of UC. Despite treatment advances, the rate of non-same-day hospitalisations for UC has also grown, though more modestly, and although mean length of stay has shortened, overall bed utilisation rates due to non-same-day UC admissions have increased. These trends appear to reflect the increasing prevalence of UC in Australia, and healthcare cost modelling must factor this in going forward.

References
1.Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open. 2023; 13(3), p. e065186. https://doi.org/10.1136/bmjopen-2022-065186
2.Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007; 5: 103-110.
3.Seah D, De Cruz P. Review article: the practical management of acute severe ulcerative colitis. Aliment PharmacolTher. 2016; 43: 482-513.
4.Lichtenstein GR, Shahabi A, Seabury SA, Lakdawalla DN, Espinosa OD, Green S, Brauer M, Baldassano RN. Lifetime Economic Burden of Crohn's Disease and Ulcerative Colitis by Age at Diagnosis. Clin Gastroenterol Hepatol. 2020; 18(4):889-897. https://doi.org/10.1016/j.cgh.2019.07.022