Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation.
OBJECTIVE
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 Euro/patient-year for inflammatory bowel disease, 1524 Euro/patient-year for ulcerative colitis, and 2548 Euro/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 Euro/patient-year in Denmark and 888 Euro/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.
Odes
Selwyn
S
Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel. odes@bgumail.bgu.ac.il
Vardi
Hillel
H
Friger
Michael
M
Wolters
Frank
F
Russel
Maurice G
MG
Riis
Lene
L
Munkholm
Pia
P
Politi
Patrizia
P
Tsianos
Epameinondas
E
Clofent
Juan
J
Vermeire
Severine
S
Monteiro
Estela
E
Mouzas
Iannis
I
Fornaciari
Giovanni
G
Sijbrandij
Jildou
J
Limonard
Charles
C
Van Zeijl
Gilbert
G
O'morain
Colm
C
Moum
Bjørn
B
Vatn
Morten
M
Stockbrugger
Reinhold
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012044:Regression Analysis