Browsing by Author "Coward, Stephanie"

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    Forecasting the Future: A Trek through the Changing Landscape of Inflammatory Bowel Disease
    (2019-06-06) Coward, Stephanie; Kaplan, Gilaad G.; Clement, Fiona M.; McBrien, Kerry Alison; Hazlewood, Glen S.; Congly, Stephen E.
    Inflammatory bowel disease (IBD) is an immune-mediated disease of the gastrointestinal tract. It imparts a lifelong burden once diagnosed, which can lead to medication reliance, hospitalizations, and surgeries. Previous research has elucidated the current state of knowledge on IBD, but what is missing from the field are analyses of IBD-related outcomes within a specific population, and analyses of what these outcomes mean for the future of IBD in that population.1,2 Therefore, the aim of this thesis is to give an overarching understanding of the current burden of IBD; forecast the future burden; and, illustrate what these findings mean for the future of Canadians and our healthcare systems. Administrative data were used to identify prevalent cases from seven provinces (95% of the Canadian population). In Alberta specifically, prevalent and incident cases were isolated and data on hospitalizations, surgeries, medications, and all-cause mortality data were obtained. Using regression analyses, temporal trends of prevalence, incidence, hospitalization (total, IBD-related, and IBD-specific), surgery, biologics (an expensive medication increasing in popularity for the treatment of IBD), and mortality were analyzed. Data on prevalence from all seven provinces were analyzed and forecasted to 2030. Alberta-specific data were used to forecast incidence to 2030, and hospitalizations and surgeries to 2021. Overall, the prevalence of IBD in Canada is significantly increasing. By 2030, an estimated 402,853 Canadians will be living with IBD. In Alberta, incidence is forecasted to continue to significantly decrease from 2015 through to 2030. Hospitalizations and surgeries have also been significantly decreasing in Alberta and are forecasted to continue decreasing through to 2021. The proportion of patients dispensed biologics has been significantly increasing, which is indicative of an increasing utilization of this medication. Finally, the mortality rate has remained stable. While the decrease of adverse IBD-related outcomes (e.g., hospitalization and surgery) prove to be beneficial for patients with IBD and healthcare systems, the significant increase in the number of people with the disease may still overwhelm the system and inhibit patients from receiving necessary care.
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    Funding a Smoking Cessation Program for Patients with Crohn's Disease: An Economic Evaluation
    (2014-07-10) Coward, Stephanie; Kaplan, Gilaad
    Crohn’s disease (CD) is increasing in incidence and prevalence in Canada. It is diagnosed relatively early in life, and is a life-long burden to those who have it. Numerous risk factors have been associated with the development and exacerbation of CD, but one of the most prevalent modifiable risk factors is smoking; people who smoke have a higher likelihood of developing CD than those who do not smoke. Those who smoke after CD development experience more deleterious events during their disease course compared to those who do not smoke. The health care system does not regularly supply smoking cessation programs for these individuals, nor fund them, even though it has been shown that CD patients have a higher rate of smoking cessation than the general population. Therefore, the goal of this thesis is to assess the cost-effectiveness of funding smoking cessation programs for incidence cases of CD.