P1215Fibrotic Complications in Ulcerative Colitis: A Real-World Analysis of Healthcare Resource Utilization (HCRU) and Treatment Journey

Abstract Background Clinical complications of fibrosis, such as strictures and obstructions, are well known in Crohn’s disease, but their prevalence and economic burden remain poorly characterized in ulcerative colitis (UC). We evaluated the healthcare resource utilization (HCRU) and treatment patterns in UC patients with or without fibrotic complications. Methods This retrospective cohort study used de-identified data from Maccabi Healthcare Services, an Israeli insurer-provider. Patients with confirmed UC diagnosis, without colorectal malignancies, during 2002-2024, who developed fibrotic complications, were matched 1: 3 by age and diagnosis period to UC patients without complications. We defined fibrotic complications as obstruction, stricture, or stenosis post-UC diagnosis. Outcomes included HCRU, medication use, and costs. Analyses were stratified by time since UC diagnosis and pre- and post-fibrotic complications periods. Poisson regression was used to test group differences. Results We identified 100 cases with fibrotic complications among 6, 994 patients with UC. Compared to matched controls, they used more biologics in years 0-3, 3-5, and 5-7 (RR95%CI = 1. 99 1. 36-2. 87; 1. 98 1. 20-3. 23; 1. 99 1. 14-3. 37), had higher corticosteroid (CS) use in years 0-3 and 3-5 (RR95%CI = 3. 891. 83-8. 37; 3. 241. 43-7. 33), but lower 5-aminosalicylates (5-ASA) use through their disease course (RR ranged from 0. 51 to 0. 63). Immunomodulator (IM) use was higher only in years 0-3 (RR95%CI = 1. 841. 08-3. 06). HCRU was higher among patients with fibrotic complications across all periods, with the largest differences in years 3-5 (RR95%CI = 2. 812. 19-3. 59 for ER visits; 3. 752. 93-4. 82 for hospitalizations; 6. 265. 62-6. 98 for hospitalization days; 1. 361. 30-1. 42 for physician visits). Endoscopy/imaging rates were higher only in years 7-10 (RR95%CI = 1. 511. 36-1. 67). Changes in overall rates of hospitalizations, hospitalization days, and physician visits were greater in cases (69%, 159%, 11%, respectively; all p 0. 001) (Figure 1A). 5-ASA (36%, p = 0. 02) from pre- to post fibrotic complications. Overall biologic use (62%, p = 0. 008) decreased from pre- to post-fibrotic complications among cases and increased in controls, with no significant changes in CS and IM use, or in medication costs (Figure 1B). Total medication costs (1000s) were consistently higher among cases, with the highest costs observed in the years 0-3 (median IQR = 7. 102. 71, 22. 42 vs. 3. 811. 63, 7. 22). Conclusion UC patients who develop fibrotic complications experience substantially higher HCRU, medication costs, and intensified therapy, particularly biologics and corticosteroids, from early in the disease course, with a further rise in HCRU after diagnosis of fibrotic complications. Conflict of interest: Dr. Shapiro, Ilona: No conflict of interest Igho-Osagie, Ebuwa: Employee of Merck & Co. Sharman Moser, Sarah: No conflict of interest Lawlor, Garrett: Employee of Merck & Co. Hoshen, Moshe: No conflict of interest Liu, Gui: Employee of Merck & Co. , Inc. Gazit, Sivan: No conflict of interest Rieder, Florian: No conflict of interest Ben-Tov, Amir: No conflict of interest