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Cost of Illness of Crohn’s Disease

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Abstract

Crohn’s disease is a chronic inflammatory bowel disease of unknown aetiology which affects around 35 000 people in the UK (population 56.8 million). The potential for onset in early adult life, disease chronicity and a need for hospitalisation and surgery mean that the disease can be associated with substantial healthcare costs.

Cost-of-illness studies focusing on direct medical costs have identified that over half the average costs associated with the disease relate to hospital costs. Estimates of the contribution of drug costs to the total direct economic burden have varied between 4.6 and 25%. Figures for average annual direct costs per patient in the US have been put at between $US6561 (1990 values) and $US12 417 (1994 values), whereas European studies have given much lower cost estimates ($US655, 1994 values). However, all studies have highlighted that much of the total cost of illness relates to extensive interventions required by a small proportion of severely affected individuals. Indirect costs associated with reduced productivity in Crohn’s disease can be high, with long periods of absenteeism and early disability. However, most patients (90%) remain in the workforce and life expectancy is relatively normal.

A variety of drugs are employed for the treatment of Crohn’s disease, both in an attempt to induce clinical remission in active disease and to maintain remission once this has been achieved. Comparative data on cost effectiveness is lacking, though crude estimates based on randomised trials suggest that the frequently prescribed aminosalicylates, which have only modest efficacy, are a relatively costly drug option. The costs associated with adverse drug effects, particularly for corticosteroids, have not been formally quantified.

Despite high costs, new drug therapies for more severe disease, such as anti-tumour necrosis factor (TNF-α) antibodies, may prove a cost-effective option if the need for hospitalisation is reduced. In a modelling exercise, a US group estimated that if a theoretical new drug was introduced which was capable of reducing non-drug costs (including hospitalisation) by a fifth despite doubling the overall drugs bill, there would still be a reduction in the overall costs of Crohn’s disease by 13%. Although surgical therapy is costly, there may be prolonged post-surgical remission following resection of localised disease and early surgery may represent a cost-effective option for selected patients.

Without formal cost-effectiveness analyses, or (better still) clinical trials incorporating cost data, decisions about the relative efficiency of treatment alternatives for Crohn’s disease remain subjective and more research is clearly required in this area.

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References

  1. Bodger K, Daly MJ, Heatley RV, et al. Clinical economics in gastroenterology. In: Bodger K, Daly MJ, Heatley RV, editors. Clinical economics in gastroenterology. 1st ed. Oxford: Blackwell Science Ltd, 2000: 1–11

    Google Scholar 

  2. Forbes A. Clinical presentations. In: Forbes A. Clinicians’ guide to inflammatory bowel disease. London: Chapman & Hall Medical, 1997: 45–85

    Google Scholar 

  3. Calkins B, Mendeloff A. Epidemiology of inflammatory bowel disease. Epidemiol Rev 1986; 8: 60–91

    PubMed  CAS  Google Scholar 

  4. Stowe S, Redmond S, Stormont J, et al. An epidemiologic study of inflammatory bowel disease in Rochester, New York. Gastroenterology 1990; 98: 104–16

    PubMed  CAS  Google Scholar 

  5. Ranzi T, Bodini P, Zambelli A, et al. Epidemiological aspects of inflammatory bowel disease in a north Italian population: a 4 year prospective study. Eur J Gastroenterol Hepatol 1996; 8: 657–61

    PubMed  CAS  Google Scholar 

  6. Srivastava ED, Mayberry JF, Morris TJ, et al. Incidence of ulcerative colitis in Cardiff over 20 years: 1968-87. Gut 1992; 33: 256–8

    Article  PubMed  CAS  Google Scholar 

  7. Gower-Rousseau C, Salomez J-L, Dupas J-L, et al. Incidence of inflammatory bowel disease in northern France (1988–1990). Gut 1994; 35: 1433–8

    Article  PubMed  CAS  Google Scholar 

  8. Munkholm P, Langholz E, Nielson OH, et al. Incidence and prevalence of Crohn’s disease in the county of Copenhagen, 1962–87: a sixfold increase in incidence. Scand J Gastroenterol 1992; 27: 609–14

    Article  PubMed  CAS  Google Scholar 

  9. Russel MG, Stockbrugger RW. Epidemiology of inflammatory bowel disease. Scand J Gastroenterol 1996; 31: 417–27

    Article  PubMed  CAS  Google Scholar 

  10. Eisen GM, Sandler RS. Update on the epidemiology of IBD. Prog Inflamm Bowel Dis 1994; 15: 1–8

    Google Scholar 

  11. Rubin GP, Hungin AP, Kelly PJ, et al. Inflammatory bowel disease: epidemiology andmanagement in an English general practice population. Aliment Pharmacol Ther 2000; 14 (12): 1553–9

    Article  PubMed  CAS  Google Scholar 

  12. Silverstein MD, Loftus EV, Sandborn WJ, et al. Clinical course and costs of care for Crohn’s disease: Markov Model Analysis of a population-based cohort. Gastroenterology 1999; 117: 49–57

    Article  PubMed  CAS  Google Scholar 

  13. Rhodes J, Thomas G, Evans BK. Inflammatory bowel disease management. Drugs 1997; 53 (2): 189–94

    Article  PubMed  CAS  Google Scholar 

  14. Gibson P. Inflammatory bowel disease: current concepts in pathogenesis and therapy. Clin Immunother 1994; 2 (2): 134–60

    Article  Google Scholar 

  15. Hanauer SB, Stathopoulos G. Risk-benefit assessment of drugs used in the treatment of inflammatory bowel disease. Drug Saf 1991; 6 (3): 192–219

    Article  PubMed  CAS  Google Scholar 

  16. Griffiths AM, Ohlsson A, Sherman PM, et al. Meta-analysis of enteral nutrition as a primary treatment of active Crohn’s disease. Gastroenterology 1995; 108: 1056–67

    Article  PubMed  CAS  Google Scholar 

  17. Becker JM. Surgical therapy for ulcerative colitis and Chron’s disease. Gastroenterol Clin North Am 1999; 28 (2): 371–90

    Article  PubMed  CAS  Google Scholar 

  18. Yacyshyn BR. New biotechnological therapies for Crohn’s disease: where are we now? BioDrugs 1998; 10 (4): 301–16

    Article  PubMed  CAS  Google Scholar 

  19. Blomqvist P, Ekbom A. Inflammatory bowel disease: health care and costs in Sweden in 1994. Scand J Gastrenterol 1997; 32: 1134–9

    Article  CAS  Google Scholar 

  20. Pinchbeck BR, Kirdeikis J, Thompson ABR. Economic impact of inflammatory bowel disease in Alberta. Can J Gastroenterol 1988; 2 (2): 53–6

    Google Scholar 

  21. Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol 1992; 14 (4): 309–17

    Article  PubMed  CAS  Google Scholar 

  22. Spivak W, Sockolow R, Rigas A. The relationship between Insurance class and severity of presentation of inflammatory bowel disease in children. Am J Gastroenterol 1995; 90 (6): 982–7

    PubMed  CAS  Google Scholar 

  23. Feagan BG, Vreeland MG, Larson LR, et al. annual cost of care for Crohn’s disease: A Payor Perspective. Am J Gastroenterol 2000; 95: 1955–60

    Article  PubMed  CAS  Google Scholar 

  24. Bernstein CN, Papineau N, Zajaczkowski J, et al. Direct hospital costs for patients with inflammatory bowel disease in a Canadian Tertiary care university hospital. Am J Gastroenterol 2000; 95: 677–83

    Article  PubMed  CAS  Google Scholar 

  25. Russell D, Cohen MD, Larson LR, et al. The cost of hospitalisation in Crohn’s disease. Am J Gastroenterol 2000; 95: 524–30

    Article  Google Scholar 

  26. Hay AR, Hay JW. Inflammatory bowel disease: medical cost algorithms. J Clin Gastroenterol 1992; 14 (4): 318–27

    Article  PubMed  CAS  Google Scholar 

  27. Monthly index of medical specialties. London: Haymarket Medical Ltd, 2001 Feb

  28. Summers RW, Switz DM, Sessions JT, et al. National Co-operative Crohn’s Disease Study: results of drug treatment. Gastroenterology 1979; 77: 847–69

    PubMed  CAS  Google Scholar 

  29. Malchow H, Ewe K, Brandes JW, et al. European Cooperative Crohn’s Disease Study (ECCDS): results of drug treatment. Gastroenterology 1984; 86: 249–66

    PubMed  CAS  Google Scholar 

  30. Rasmussen SN, Lauritsen K, Tage-Jensen U, et al. 5-aminosalicylle acid in the treatment of Crohn’s disease: a 16-week double-blind, placebo-controlled, multicentre study with Pentasa. Scand J Gastroenterol 1987; 22: 877–83

    Article  PubMed  CAS  Google Scholar 

  31. Singleton JW, Hanauer SB, Gitnick GL, et al. Mesalamine capsules for the treatment of active Crohn’s disease: results of a 16-week trial. Gastroenterology 1993; 104: 1293–301

    PubMed  CAS  Google Scholar 

  32. Greenberg GR, Feagan BG, Martin F, et al. Oral budesonide for active Crohn’s disease. Canadian Inflammatory Bowel Disease Study Group. N Engl J Med 1994; 331: 836–41

    Article  PubMed  CAS  Google Scholar 

  33. Sutherland L, Singleton J, Sessions J, et al. Double blind, placebo controlled trial of metronidazole in Crohn’s disease. Gut 1991; 32: 1071–5

    Article  PubMed  CAS  Google Scholar 

  34. Singleton J. Second trial of mesalamine therapy in the treatment of active Crohn’s disease. Gastroenterology 1994; 107 (2): 632–9

    PubMed  CAS  Google Scholar 

  35. Scholmerich J, Jenss H, Hartmann F, et al. The German 5-ASA Study Group. Oral 5aminosalicylic acid versus 6-methylprednisolone in active Crohn’s disease. Can J Gastroenterol 1990; 4 (7): 446–51

    Google Scholar 

  36. Maier K, Frick H-J, von Gaisberg U, et al. Clinical efficacy of oral mesalazine in Crohn’s disease. Can J Gastroenterol 1990; 4 (l): 13–8

    Google Scholar 

  37. Martin F, Sutherland L, Beck IT, et al. Oral 5-ASA versus prednisone in short term treatment of Crohn’s disease: a multicentre controlled trial. Can J Gastroenterol 1990; 4 (7): 452–7

    Google Scholar 

  38. Prantera C, Cottone M, Pallone F, et al. Mesalamine in the treatment of mild to moderate active Crohn’s ileitis: results of a randomized, multicenter trial. Gastroenterology 1999 Mar; 116 (3): 521–6

    Google Scholar 

  39. Rutgeerts P, Loftberg R, Malchow H, et al. A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med 1994; 331 (13): 842–5

    Article  PubMed  CAS  Google Scholar 

  40. Prantera C, Zannoni F, Scribano ML, et al. An antibiotic regimen for the treatment of active Crohn’s disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol 1996; 2: 328–32

    Google Scholar 

  41. Bernstein LH, Frank MS, Brandt LJ, et al. Healing of perianal Crohn’s disease with metronidazole. Gastroenterology 1980; 79: 357–65

    PubMed  CAS  Google Scholar 

  42. Brook BN, Hoffmann DC, Swarbrick ET. Azathioprine for Crohn’s disease. Lancet 1969; 2: 612–64

    Article  Google Scholar 

  43. Sandborn WJ, Sutherland L, Pearson D, et al. Azathioprine or 6-mercaptopurine for inducing remission of Crohn’s disease (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Oxford Update Software, 2002

    Google Scholar 

  44. Feagan BG. Aminosalicylates for active disease and in the maintenance of remission in Crohn’s disease. Eur J Surg 1998; 164 (12): 903–9

    Article  PubMed  CAS  Google Scholar 

  45. Lapidus A, Bernell O, Hellers G, et al. Clinical course of colorectal Crohn’s disease: a 35-year follow-up study of 507 patients. Gastroenterology 1998; 114 (6): 1151–60

    Article  PubMed  CAS  Google Scholar 

  46. Camma C, Giunta M, Roselli M, et al. Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology 1997; 13: 1465–73

    Article  Google Scholar 

  47. Trallori G, Messori A. Drug treatments for maintaining remission in Crohn’s disease: a lifetime cost-utility analysis. Pharmacoeconomics 1997; 11 (5): 444–53

    Article  PubMed  CAS  Google Scholar 

  48. Pearson DC, May GR, Fick G, et al. Azathioprine for maintaining remission of Crohn’s disease (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Oxford Update Software, 2002

    Google Scholar 

  49. Blomqvist P, Feltelius N, Loftberg R, et al. A 10-year survey of inflammatory bowel diseases - drug therapy, costs and adverse reactions. Aliment Pharmacol Ther 2001; 15: 475–81

    Article  PubMed  CAS  Google Scholar 

  50. Fernandez-Banares F, Cabre E, Esteve-Comas M, et al. How effective is enteral nutrition in inducing clinical remission in active Crohn’s disease? A meta-analysis of the randomized clinical trials. JPEN J Parenter Enteral Nutr 1995; 19: 356–64

    Article  PubMed  CAS  Google Scholar 

  51. Ofman J, Koretz RL. Nutritional support: efficacy and cost-effectiveness. In: Bodger K, Daly MJ, Heatley RV, editors. Clinical economics in gastroenterology. 1st ed. Oxford: Blackwell Science Ltd, 2000: 188–219

    Google Scholar 

  52. Picco MF, Bayless TM. Analysing hospital costs for patients with inflammatory bowel disease. Am J Gastroenterol 2000; 95: 577–8

    Article  PubMed  CAS  Google Scholar 

  53. Guillou PJ, Windsor AJ, Nejim A. The health care economic implications of minimal access gastrointestinal surgery. In: Bodger K, Daly MJ, Heatley RV, editors. Clinical economics in gastroenterology. 1st ed. Oxford: Blackwell Science Ltd, 2000: 133–45

    Google Scholar 

  54. Ogunbiyi OA, Fleshman JW. Place of laparoscopic surgery in Crohn’s disease. Baillieres Clin Gastroenterol 1998 Mar; 12 (1): 157–65

    Google Scholar 

  55. Van Dullemen HM, Van Deventer SJH, Hommes DW, et al. Treatment of Crohn’s disease with anti-tumour necrosis factor chimeric monoclonal antibody (cA2). Gastroenterology 1995; 109: 29–135

    Google Scholar 

  56. Targan SR, Hanauer SB, Sander HH, et al. A short-term study of chimeric monoclonal antibody cA2 to tumour necrosis factor alpha for Crohn’s disease. N Engl J Med 1997; 337: 1029–35

    Article  PubMed  CAS  Google Scholar 

  57. Arseneau KO, Cohn SM, Cominelli F, et al. Cost-utility of initial medical management for Crohn’s disease perianal fistulae. Gastroenterology 2001; 120: 1640–56

    Article  PubMed  CAS  Google Scholar 

  58. Feagan BG. review article: economic issues in Crohn’s disease - assessing effects of new treatments on health-related quality of life. Aliment Pharmacol Ther 1999; 13 Suppl. 4: 29–37

    Article  PubMed  Google Scholar 

  59. Probert CSJ, Mayberry JF. Inflammatory bowel disease; Patient expectations in the 1990’s. J Social Med 1991; 84: 131–2

    CAS  Google Scholar 

  60. Moody A, Mayberry JF. Life insurance and inflammatory bowel disease: is there discrimination against patients? Int J Colorectal Dis 1996; 11: 276–8

    Article  PubMed  CAS  Google Scholar 

  61. Beck T, Leddin DJ, Lemire SE, et al. Insurance rating of patients with inflammatory bowel disease: report of a conference on morbidity and mortality. Can J Gastroenterol 1994; 8 (7): 309–17

    Google Scholar 

  62. Ward FM, Bodger K, Daly MJ, et al. Clinical economics review: medical management of inflammatory bowel disease. Aliment Pharmacol Ther 1999; 13 (1): 15–25

    Article  PubMed  CAS  Google Scholar 

  63. Sonnenberg A. Disability from inflammatory bowel disease among employees in West Germany. Gut 1989 Dec; 30 (12): 1798–800

    Google Scholar 

  64. Sonnenberg A. Disability and need for rehabilitation among patientswith inflammatory bowel disease. Digestion 1992; 51 (3): 168–78

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Medicine, Clinical Sciences Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK

    Keith Bodger

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Bodger, K. Cost of Illness of Crohn’s Disease. Pharmacoeconomics 20, 639–652 (2002). https://doi.org/10.2165/00019053-200220100-00001

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