OBJECTIVES. To compare inflammatory bowel disease (IBD) progression and healthcare resource utilization in patients with and without a co-diagnosis of iron-deficiency anemia (IDA) in a real-world setting.

METHODS. A retrospective study was conducted using Italian entities' administrative databases, covering around 9.3 million health-assisted individuals. Adult IBD patients [diagnosed by ≥1 hospitalization for ulcerative colitis and/or Crohn’s disease, and/or active exemption code, and/or one prescription for Vedolizumab] were enrolled across January 2010-September 2017. Within 12 months from IBD diagnosis, IDA was identified by ≥1prescription for iron and/or other anemia treatments and/or IDA hospitalization and/or blood transfusion (proxy of diagnosis). IBD patients were grouped into those with and without IDA. Due to the non-random allocation of patients, the Propensity Score Matching (PSM) methodology was applied to abate potential unbalances among the two cohorts. In PSM matched-cohorts, the IBD disease progression (in terms of IBD-related hospitalizations and surgeries), healthcare resource utilization, and costs [for drugs, outpatient specialist services (OSS), and hospitalizations] were assessed during follow-up (12 months).

RESULTS. Overall, 13,475 IBD patients were enrolled; post-PSM, 5,259 IBD-without-IDA and 1,753 IBD-IDA patients were included in the study (mean age 55 and 56 years, 43% and 44% male, respectively). The percentage of IBD-IDA patients with IBD-related hospitalizations (12%) and IBD-related surgeries (3%) was significantly higher than hospitalization and surgery extent found in IBD-without-IDA patients (6% and 2%, respectively). The average annual healthcare number of resource utilization per patient in terms of drug prescriptions (16 vs. 13.2), hospitalizations (0.5 vs. 0.3), and OSS (9.7 vs. 7.1) was significantly increased in IBD-IDA versus IBD-without-IDA patients. The overall average cost per patient of IBD-IDA patients were significantly higher than that of IBD-without-IDA patients (5,317€ vs. 3,198€).

CONCLUSIONS. In a real-life setting, the presence of IDA in patients with IBD might result in worst disease progression, higher healthcare resource utilization, and higher cost.