title: Costs of ulcerative colitis from a societal perspective in a regional health care area in Spain: A database study.
abstract: OBJECTIVE
  To estimate the management of UC associated costs from the societal perspective in Spain.
  
  
  METHODS
  Observational, longitudinal study with retrospective data collection based on reviews of outpatient health records. Socio-demographic, clinical and sick leave information was gathered. Patients diagnosed of UC between 2002 and 2012, older than 18 years, followed-up by a minimum of 12 months post diagnosis, with at least two clinical and use of resources data recorded, were included.
  
  
  RESULTS
  285 UC patients [51.2% men; 44.5 (SD: 15.6) years old; 88.4% without family history of UC; 39.3% proctitis; 5.6 (2.5) years disease follow-up] participated. More than half (65.6%) were active workers, 75.9% were on sick leave for reasons different from UC [mean 0.66 (0.70) times per year] during (mean) 28.43 (34.45) days. Only 64 patients were on UC-related sick-leaves, lasting (mean) 26.17 (37.43) days. Absenteeism due to medical visits caused loss of 29.55 (21.38) working hours per year. Mean direct and indirect annual cost per UC patient were €1754.10 (95%CI: 1473.37-2034.83) and €399.32 (282.31-422.69), respectively. Absenteeism was estimated at €88.21(32.72-50.06) per patient per year, in which sick-leaves were the main component of indirect costs (88.2%). Age, UC family history, diarrhea at diagnosis, blood and blood-forming organs diseases and psychological disorders were the main predictors of indirect costs.
  
  
  CONCLUSIONS
  UC is a costly disease for the society and the Spanish National Healthcare System. Indirect costs imply a major burden by affecting the most productive years of patients. Further research is needed considering all components of productivity loss, including presenteeism-associated costs.
authors.affiliation: Hospital Universitari Doctor Josep Trueta, Girona, Spain. Electronic address: xaldeguer@idibgi.org.
authors.forename: Xavier
authors.initials: X
authors.lastname: Aldeguer
authors.affiliation: Badalona Serveis Assistencials, Badalona, Spain. Electronic address: asicras@bsa.cat.
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras-Mainar
mesh_terms: D000041:Absenteeism; D000328:Adult; D003093:Colitis, Ulcerative / Q000191:economics*; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D012189:Retrospective Studies; D013030:Spain
keywords: Colitis ulcerosa; Gastos indirectos; Indirect costs; Productivity loss; Pérdida de productividad; Ulcerative colitis