title: Healthcare costs of inflammatory bowel disease have shifted from hospitalisation and surgery towards anti-TNFα therapy: results from the COIN study.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, , Utrecht, The Netherlands.
authors.forename: Mirthe Emilie
authors.initials: ME
authors.lastname: van der Valk
authors.forename: Marie-Josée J
authors.initials: MJ
authors.lastname: Mangen
authors.forename: Max
authors.initials: M
authors.lastname: Leenders
authors.forename: Gerard
authors.initials: G
authors.lastname: Dijkstra
authors.forename: Ad A
authors.initials: AA
authors.lastname: van Bodegraven
authors.forename: Herma H
authors.initials: HH
authors.lastname: Fidder
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: de Jong
authors.forename: Marieke
authors.initials: M
authors.lastname: Pierik
authors.forename: C Janneke
authors.initials: CJ
authors.lastname: van der Woude
authors.forename: Mariëlle J L
authors.initials: MJ
authors.lastname: Romberg-Camps
authors.forename: Cees H M
authors.initials: CH
authors.lastname: Clemens
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Jansen
authors.forename: Nofel
authors.initials: N
authors.lastname: Mahmmod
authors.forename: Paul C
authors.initials: PC
authors.lastname: van de Meeberg
authors.forename: Andrea E
authors.initials: AE
authors.lastname: van der Meulen-de Jong
authors.forename: Cyriel Y
authors.initials: CY
authors.lastname: Ponsioen
authors.forename: Clemens J M
authors.initials: CJ
authors.lastname: Bolwerk
authors.forename: J Reinoud
authors.initials: JR
authors.lastname: Vermeijden
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
mesh_terms: D000041:Absenteeism; D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000191:economics / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D017281:Cost of Illness; D003424:Crohn Disease / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn's Disease; Economic Evaluation; Inflammatory Bowel Disease; Ulcerative Colitis