Gastroenterology

Gastroenterology

Volume 131, Issue 3, September 2006, Pages 719-728
Gastroenterology

Clinical–alimentary tract
Cost Analysis and Cost Determinants in a European Inflammatory Bowel Disease Inception Cohort With 10 Years of Follow-up Evaluation

https://doi.org/10.1053/j.gastro.2006.05.052Get rights and content

Background & Aims: Economic analysis in chronic diseases is a prerequisite for planning a proper distribution of health care resources. We aimed to determine the cost of inflammatory bowel disease, a lifetime illness with considerable morbidity. Methods: We studied 1321 patients from an inception cohort in 8 European countries and Israel over 10 years. Data on consumption of resources were obtained retrospectively. The cost of health care was calculated from the use of resources and their median prices. Data were analyzed using regression models based on the generalized estimating equations approach. Results: The mean annual total expenditure on health care was 1871€/patient-year for inflammatory bowel disease, 1524€/patient-year for ulcerative colitis, and 2548€/patient-year for Crohn’s disease (P < .001). The most expensive resources were medical and surgical hospitalizations, together accounting for 63% of the cost in Crohn’s disease and 45% in ulcerative colitis. Total and hospitalization costs were much higher in the first year after diagnosis than in subsequent years. Differences in medical and surgical hospitalizations were the primary cause of substantial intercountry variations of cost; the mean cost of health care was 3705€/patient-year in Denmark and 888€/patient-year in Norway. The outlay for mesalamine, a costly medication with extensive use, was greater than for all other drugs combined. Patient age at diagnosis and sex did not affect costs. Conclusions: In this multinational, population-based, time-dependent characterization of the health care cost of inflammatory bowel disease, increased expenditure was driven largely by country, diagnosis, hospitalization, and follow-up year.

Section snippets

Patients

The EC-IBD created a prospective, uniformly diagnosed, population-based inception cohort of 2201 patients with inflammatory bowel disease within 20 well-described geographic areas in 11 European countries and Israel during the inception period from October 1, 1991 to September 30, 1993.10 The geographic regions and study area populations were described in detail previously. The population was required to be stable, with little immigration or emigration, and to number not less than 250,000

Cohort Characteristics

Fifteen patients with indeterminate colitis were excluded because their small number precluded analysis. The remaining 1324 inflammatory bowel disease patients included those with full data (1273 patients), demographics only (3 patients), diagnostics only (8 patients), and medications only (40 patients). The cost analysis was performed on 1321 patients with economic data, omitting the 3 patients who had only demographic records. Pertinent demographic and clinical features of these 1321 patients

Discussion

The present cost-analysis of health care in inflammatory bowel disease has several advantages over previous studies. The cohort considered of population-based, uniformly diagnosed, incident patients derived from 9 countries. The long study period captured 10 years of downstream costs related to the natural progression of the illness as modified by therapy. Information about resource use was as comprehensive as possible, incorporating data from the level of the general practitioner to the

References (29)

  • A.R. Hay et al.

    Inflammatory bowel disease: medical cost algorithms

    J Clin Gastroenterol

    (1992)
  • P. Blomqvist et al.

    Inflammatory bowel diseases: health care and costs in Sweden in 1994

    Scand J Gastroenterol

    (1997)
  • M. Ebinger et al.

    Cost of outpatient care in patients with inflammatory bowel disease in a German University Hospital

    J Gastroenterol Hepatol

    (2004)
  • A. Bassi et al.

    Cost of illness of inflammatory bowel disease in the UK: a single centre retrospective study

    Gut

    (2004)
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    Published in part as an abstract of similar title in Gastroenterology 2005;128(Suppl):A324.

    Supported by the European Commission as a fifth framework shared cost action (QLG4-CT-2000-01414).

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