title: Systematic review: the costs of ulcerative colitis in Western countries.
abstract: BACKGROUND
  Early onset and complications such as hospitalization and surgery contribute to the economic burden of ulcerative colitis.
  
  
  OBJECTIVE
  To review systematically the literature on costs of ulcerative colitis in Western countries.
  
  
  METHODS
  Studies estimating costs of ulcerative colitis in Western countries were identified using Medline, EMBASE and ISI Web of Science and were rated based on relevance and reliability of estimates. All costs were adjusted to 2008 currency values. A parallel review focused on the impact of disease severity on costs, hospitalizations and surgeries.
  
  
  RESULTS
  Estimated annual per-patient direct medical costs of ulcerative colitis ranged from $6217 to $11,477 in the United States and from euro8949 to euro10,395 in Europe. Hospitalizations accounted for 41-55% of direct medical costs. Indirect costs accounted for approximately one-third of total costs in the United States and 54-68% in Europe. Total economic burden of ulcerative colitis was estimated at $8.1-14.9 billion annually in the United States and at euro12.5-29.1 billion in Europe; total direct costs were $3.4-8.6 billion in the United States and euro5.4-12.6 billion in Europe. Direct costs, hospitalizations and surgeries increased with worsening disease severity.
  
  
  CONCLUSIONS
  Ulcerative colitis is a costly disease. Hospitalizations contribute significantly to direct medical costs, and indirect costs are considerable, having previously been substantially underestimated.
authors.affiliation: Department of Medicine, Section of Gastroenterology, University of Chicago Medical Center, Chicago, IL 60637, USA. rcohen@medicine.bsd.uchicago.edu
authors.forename: R D
authors.initials: RD
authors.lastname: Cohen
authors.forename: A P
authors.initials: AP
authors.lastname: Yu
authors.forename: E Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: J
authors.initials: J
authors.lastname: Xie
authors.forename: P M
authors.initials: PM
authors.lastname: Mulani
authors.forename: J
authors.initials: J
authors.lastname: Chao
mesh_terms: D002170:Canada; D003093:Colitis, Ulcerative / Q000191:economics*; D017281:Cost of Illness; D005060:Europe; D006760:Hospitalization / Q000191:economics; D006801:Humans; D014481:United States