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Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study
J. Burisch, H. Vardi, D. Schwartz, M. Friger, G. Kiudelis, J. Kupčinskas, M. Fumery, C. Gower-Rousseau, L. Lakatos, PL. Lakatos, R. D'Incà, A. Sartini, D. Valpiani, M. Giannotta, N. Arebi, D. Duricova, M. Bortlik, S. Chetcuti Zammit, P. Ellul, N....
Language English Country Netherlands
Document type Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Biological Products economics therapeutic use MeSH
- Digestive System Surgical Procedures economics MeSH
- Crohn Disease diagnosis economics therapy MeSH
- Diagnostic Techniques and Procedures economics MeSH
- Adult MeSH
- Hospitalization economics MeSH
- Middle Aged MeSH
- Humans MeSH
- Health Care Costs statistics & numerical data trends MeSH
- Follow-Up Studies MeSH
- Prospective Studies MeSH
- Colitis, Ulcerative diagnosis economics therapy MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
BACKGROUND: Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS: The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS: The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION: Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING: Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.
1st Department of Medicine Semmelweis University Budapest Hungary
Azienda USL Toscana Centro Florence Italy
Clinic of Gastroenterology Victor Babeş University of Medicine Timisoara Romania
Department of Gastroenterology and Liver Diseases Soroka Medical Centre Beer Sheva Israel
Department of Gastroenterology Centro Hospitalar de São João EPE Porto Portugal
Department of Gastroenterology Faculty of Medicine and Health Örebro University Örebro Sweden
Department of Gastroenterology Hospital Povisa Vigo Spain
Department of Gastroenterology Moscow Regional Research Clinical Institute Moscow Russia
Department of Gastroenterology North Zealand University Hospital Frederikssund Denmark
Department of Hepatology and Gastroenterology Aarhus University Hospital Aarhus Denmark
Department of Internal Medicine Ben Gurion University of the Negev Beer Sheva Israel
Department of Internal Medicine Csolnoky Ferenc Regional Hospital Veszprem Hungary
Department of Medicine Herning Central Hospital Herning Denmark
Department of Public Health Ben Gurion University of the Negev Beer Sheva Israel
Division of Gastroenterology Mater Dei Hospital Msida Malta
Division of Gastroenterology McGill University Health Center Montreal QC Canada
Division of Gastroenterology Tartu University Hospital University of Tartu Tartu Estonia
Faculty of Health Sciences Ben Gurion University of the Negev Beer Sheva Israel
Faculty of Medicine and Health Technology Tampere University Tampere Finland
Gastroenterology Department Odense University Hospital Odense Denmark
Gastroenterology Department Slagelse Hospital Slagelse Denmark
Gastroenterology Unit Bufalini Hospital Cesena AUSL della Romagna Rimini Italy
Hull University Teaching Hospitals NHS Trust Hull UK
Hull York Medical School Hull UK
Inflammatory Bowel Disease Clinical and Research Centre ISCARE Prague Czech Republic
Inflammatory Bowel Disease Department Imperial College London London UK
Institute of Molecular Medicine University of Southern Denmark Odense Denmark
Institute of Pharmacology 1st Faculty of Medicine Charles University Prague Prague Czech Republic
IRS Center Soenderjylland University Hospital of Southern Denmark Aabenraa Denmark
Lille Inflammation Research International Center LIRIC Lille University Lille France
Medical Department The National Hospital of the Faroe Islands Torshavn Faroe Islands
Nicosia Private Practice Nicosia Cyprus
Public Health Epidemiology and Economic Health Registre Epimad Lille University Lille France
School of Medicine University of Zagreb Zagreb Croatia
UO Gastroenterologia ed Endoscopia Digestiva Hospital Morgagni Pierantoni Forlì Italy
References provided by Crossref.org
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- $a Burisch, Johan $u Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark. Electronic address: johan.burisch@regionh.dk.
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- $a Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study / $c J. Burisch, H. Vardi, D. Schwartz, M. Friger, G. Kiudelis, J. Kupčinskas, M. Fumery, C. Gower-Rousseau, L. Lakatos, PL. Lakatos, R. D'Incà, A. Sartini, D. Valpiani, M. Giannotta, N. Arebi, D. Duricova, M. Bortlik, S. Chetcuti Zammit, P. Ellul, N. Pedersen, J. Kjeldsen, JMM. Midjord, KR. Nielsen, K. Winther Andersen, V. Andersen, KH. Katsanos, DK. Christodoulou, V. Domislovic, Z. Krznaric, S. Sebastian, P. Oksanen, P. Collin, L. Barros, F. Magro, R. Salupere, HAL. Kievit, A. Goldis, IP. Kaimakliotis, JF. Dahlerup, C. Eriksson, J. Halfvarson, A. Fernandez, V. Hernandez, S. Turcan, E. Belousova, E. Langholz, P. Munkholm, S. Odes, Epi-IBD group,
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- $a BACKGROUND: Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS: The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS: The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION: Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING: Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.
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- $a Vardi, Hillel $u Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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