This study attempts to determine the actual incidence of fistula-in-ano in the European Community, which was previously uncertain despite its major negative effects on quality of life and the high cost of treatment. Our findings indicate that the incidence of fistula-in-ano in the four countries of the EU studied is significantly higher than that in the only previously published report of the incidence of fistula-in-ano in Europe. Nevertheless, our findings confirm the general perception that fistula-in-ano is a relatively uncommon disease.

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Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.

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OBJECTIVES:Fragility fractures (FF) are associated with increased mortality, deterioration in health-related quality of life and high costs. Teriparatide stimulates bone remodeling. The aim of this study was to assess the cost and health effects of teriparatide in women with postmenopausal osteoporosis (PMOP) and high risk of FF from the perspective of public healthcare system in Mexico. METHODS: Target population was women aged 70 years, with PMOP, T-score Ϫ4.0 and three clinical risk factors, with a recent vertebral fracture not candidates to receive bisphosphonates. Competing alternatives were: (1) daily subcutaneous injection of teriparatide 20mcg for 18 months and (2) no therapy. A Markov microsimulation model was developed with a 30 years time horizon divided into 6-month cycles and is composed by 5 health states: hip, vertebral, forearm and humerus fracture and death. The incidence of FF was obtained from the FRAX® algorithms for Mexican women. Efficacy data was gathered from placebo-controlled clinical trials of teriparatide. We analyzed acquisition costs of teriparatide and medical care costs due to FF. Frequency and location of fractures avoided and quality adjusted life years (QALYs) were estimated. All costs are expressed in 2010 USD (1USD:12.50MXN Pesos) RESULTS: Teriparatide avoided 324 FF per a thousand patients (hip: 43; vertebral: 164; humerus: 35; forearm: 82). The number needed to treat (NNT) to prevent one FF was 3.09. Teriparatide was slightly more expensive ($20,052 vs. $22,209 USD) but more effective, with net gains of 87 QALYs per a thousand patients. The cost per additional QALY gained with teriparatide was $24,925 (below the upper limit of 3 times the gross domestic product per capita in Mexico). Teriparatide was found to be cost-effective therapy in 80% of the simulations performed in the probabilistic sensitivity analysis. CONCLUSIONS: Teriparatide is a cost-effective intervention in women with PMOP and high risk of FF.