title: Costs and resource utilization for diagnosis and treatment during the initial year in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom Study.
abstract: BACKGROUND
  No direct comparison of health care cost in patients with inflammatory bowel disease across the European continent exists. The aim of this study was to assess the costs of investigations and treatment for diagnostics and during the first year after diagnosis in Europe.
  
  
  METHODS
  The EpiCom cohort is a prospective population-based inception cohort of unselected inflammatory bowel disease patients from 31 Western and Eastern European centers. Patients were followed every third month from diagnosis, and clinical data regarding treatment and investigations were collected. Costs were calculated in euros (€) using the Danish Health Costs Register.
  
  
  RESULTS
  One thousand three hundred sixty-seven patients were followed, 710 with ulcerative colitis, 509 with Crohn's disease, and 148 with inflammatory bowel disease unclassified. Total expenditure for the cohort was €5,408,174 (investigations: €2,042,990 [38%], surgery: €1,427,648 [26%], biologicals: €781,089 [14%], and standard treatment: €1,156,520 [22%)]). Mean crude expenditure per patient in Western Europe (Eastern Europe) with Crohn's disease: investigations €1803 (€2160) (P = 0.44), surgery €11,489 (€13,973) (P = 0.14), standard treatment €1027 (€824) (P = 0.51), and biologicals €7376 (€8307) (P = 0.31). Mean crude expenditure per patient in Western Europe (Eastern Europe) with ulcerative colitis: investigations €1189 ( €1518) (P < 0.01), surgery €18,414 ( €12,395) (P = 0.18), standard treatment €896 ( €798) (P < 0.05), and biologicals €5681 ( €72) (P = 0.51).
  
  
  CONCLUSIONS
  In this population-based unselected cohort, costs during the first year of disease were mainly incurred by investigative procedures and surgeries. However, biologicals accounted for >15% of costs. Long-term follow-up of the cohort is needed to assess the cost-effectiveness of biological agents.
authors.affiliation: 1Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark; 2Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; 3Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia; 4Private Practice, Nicosia, Cyprus; 5IBD Center ISCARE, Charles University, Prague, Czech Republic; 6Department of Gastroenterology, Hospital České Budějovice, České Budějovice, Czech Republic; 7Department of Medicine, Amager Hospital, Amager, Denmark; 8Department of Medicine, Herning Central Hospital, Herning, Denmark; 9Medical Department, Viborg Regional Hospital, Viborg, Denmark; 10Organ Center, Hospital of Southern Jutland, Aabenraa, Denmark; 11Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; 12Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark; 13Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark; 14Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia; 15Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands; 16Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; 17First Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece; 18Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland; 19First Department of Medicine, Semmelweis University, Budapest, Hungary; 20Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland; 21Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel; 22U.O. di Gastroenterologia e Endoscopia Digestiva, Az.Ospedaliera Ospedale Maggiore di Crema, Crema, Italy; 23EpiCom Northern Italy centre based in Crema a
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mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult