title: The economic and quality-of-life burden of Crohn's disease in Europe and the United States, 2000 to 2013: a systematic review.
abstract: BACKGROUND
  Crohn's disease (CD) is associated with a substantial healthcare burden that affects the patient, healthcare systems and society in general.
  
  
  OBJECTIVE
  To provide a systematic evaluation of published data relating to the economic and health-related quality-of-life (HRQoL) burden of CD in selected European countries (Germany, France, UK, Italy, Spain) and the USA since 2000.
  
  
  METHODS
  We undertook a systematic review of publications relating to CD, its economic burden and impact on HRQoL. Research questions focused on the disease costs from a societal perspective and HRQoL burden in adults and pediatric/adolescent patients according to disease stage/severity. Total, direct and indirect costs were identified, as well as the impact of CD on HRQoL measured using both generic and disease-specific instruments.
  
  
  RESULTS
  Overall, 61 publications met the research criteria (38 on costs, 23 on HRQoL). CD in the USA and Europe together was associated with annual total costs of nearly <euro>30 billion, more than half due to indirect costs. HRQoL was consistently and statistically significantly lower among CD patients compared with normal populations, due to physical, emotional and social effects.
  
  
  CONCLUSIONS
  CD is a global health problem with high societal costs and substantial HRQoL burden. High-value care pathways including cost-effective therapies will help to induce and maintain remission, reduce complications of disease and improve HRQoL.
authors.affiliation: PHMR Associates, London, UK.
authors.forename: David N
authors.initials: DN
authors.lastname: Floyd
authors.forename: Sue
authors.initials: S
authors.lastname: Langham
authors.forename: Hélène Chevrou
authors.initials: HC
authors.lastname: Séverac
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Levesque
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003424:Crohn Disease / Q000191:economics* / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018803:Models, Economic; D011237:Predictive Value of Tests; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult