Gut 63:72-79 doi:10.1136/gutjnl-2012-303376
  • Inflammatory bowel disease
  • Original article

Healthcare costs of inflammatory bowel disease have shifted from hospitalisation and surgery towards anti-TNFα therapy: results from the COIN study

  1. on behalf of the COIN study group and the Dutch Initiative on Crohn and Colitis
  1. 1Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
  3. 3Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
  4. 4Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
  5. 5Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  6. 6Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
  7. 7Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  8. 8Department of Gastroenterology and Hepatology, Orbis Medical Centre, Sittard, The Netherlands
  9. 9Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, The Netherlands
  10. 10Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  11. 11Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, The Netherlands
  12. 12Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
  13. 13Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
  14. 14Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
  15. 15Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, The Netherlands
  16. 16Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands
  17. 17Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California, USA
  1. Correspondence to Dr Bas Oldenburg, Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands;boldenbu{at}
  • Received 19 July 2012
  • Accepted 8 October 2012
  • Published Online First 7 November 2012


Objective The introduction of anti tumour necrosis factor-α (anti-TNFα) therapy might impact healthcare expenditures, but there are limited data regarding the costs of inflammatory bowel diseases (IBD) following the introduction of these drugs. We aimed to assess the healthcare costs and productivity losses in a large cohort of IBD patients.

Design Crohn's disease (CD) and ulcerative colitis (UC) patients from seven university hospitals and seven general hospitals were invited to fill-out a web-based questionnaire. Cost items were derived from a 3 month follow-up questionnaire and categorised in outpatient clinic, diagnostics, medication, surgery and hospitalisation. Productivity losses included sick leave of paid and unpaid work. Costs were expressed as mean 3-month costs per patients with a 95% CI obtained using non-parametric bootstrapping.

Results A total of 1315 CD patients and 937 UC patients were included. Healthcare costs were almost three times higher in CD as compared with UC, €1625 (95% CI €1476 to €1775) versus €595 (95% CI €505 to €685), respectively (p<0.01). Anti-TNFα use was the main costs driver, accounting for 64% and 31% of the total cost in CD and UC. Hospitalisation and surgery together accounted for 19% and <1% of the healthcare costs in CD and 23% and 1% in UC, respectively. Productivity losses accounted for 16% and 39% of the total costs in CD and UC.

Conclusions We showed that healthcare costs are mainly driven by medication costs, most importantly by anti-TNFα therapy. Hospitalisation and surgery accounted only for a minor part of the healthcare costs.

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