Evolution of Costs of Inflammatory Bowel Disease over Two Years of Follow-Up.
BACKGROUND
With the increasing use of anti-TNF therapy in inflammatory bowel disease (IBD), a shift of costs has been observed with medication costs replacing hospitalization and surgery as major cost driver. We aimed to explore the evolution of IBD-related costs over two years of follow-up.


RESULTS
In total 1,307 Crohn's disease (CD) patients and 915 ulcerative colitis (UC) patients were prospectively followed for two years by three-monthly web-based questionnaires. Changes of healthcare costs, productivity costs and out-of-pocket costs over time were assessed using mixed model analysis. Multivariable logistic regression analysis was used to identify costs drivers. In total 737 CD patients and 566 UC were included. Total costs were stable over two years of follow-up, with annual total costs of €7,835 in CD and €3,600 in UC. However, within healthcare costs, the proportion of anti-TNF therapy-related costs increased from 64% to 72% in CD (p<0.01) and from 31% to 39% in UC (p < 0.01). In contrast, the proportion of hospitalization costs decreased from 19% to 13% in CD (p<0.01), and 22% to 15% in UC (p < 0.01). Penetrating disease course predicted an increase of healthcare costs (adjusted odds ratio (adj. OR) 1.95 (95% CI 1.02-3.37) in CD and age <40 years in UC (adj. OR 4.72 (95% CI 1.61-13.86)).


CONCLUSIONS
BD-related costs remained stable over two years. However, the proportion of anti-TNF-related healthcare costs increased, while hospitalization costs decreased. Factors associated with increased costs were penetrating disease course in CD and age <40 in UC.
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Mirthe E
ME
van der Valk
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
Marie-Josée J
MJ
Mangen
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Mirjam
M
Severs
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Mike
M
van der Have
Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, the Netherlands.
Gerard
G
Dijkstra
Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, the Netherlands.|Department of Internal Medicine. Gastroenterology and Geriatrics, Atrium-Orbis Medical Centre, Heerlen-Sittard-Geleen, the Netherlands.
Ad A
AA
van Bodegraven
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Herma H
HH
Fidder
Department of Gastroenterology and Hepatology, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands.
Dirk J
DJ
de Jong
Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
C Janneke
CJ
van der Woude
Department of Internal Medicine. Gastroenterology and Geriatrics, Atrium-Orbis Medical Centre, Heerlen-Sittard-Geleen, the Netherlands.
Mariëlle J L
MJ
Romberg-Camps
Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, the Netherlands.
Cees H M
CH
Clemens
Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Jeroen M
JM
Jansen
Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, the Netherlands.
Paul C
PC
van de Meeberg
Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, the Netherlands.
Nofel
N
Mahmmod
Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands.
Andrea E
AE
van der Meulen-de Jong
Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands.
Cyriel Y
CY
Ponsioen
Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, the Netherlands.
Clemens
C
Bolwerk
Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, the Netherlands.
J Reinoud
JR
Vermeijden
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Peter D
PD
Siersema
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Max
M
Leenders
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Bas
B
Oldenburg
D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000191:economics*
D014409:Tumor Necrosis Factor-alpha