title: Costs of Crohn's Disease According to Severity States in France: A Prospective Observational Study and Statistical Modeling over 10 Years.
abstract: To describe the medico-economic characteristics of Crohn's disease (CD), we implemented a multicenter study in France.
  
  
  
  From 2004 to 2006, disease severity states, direct (hospital and extra hospital) and indirect costs were prospectively collected over 1 year in patients with CD naive from anti-tumor necrosis factor alpha (infliximab) at inclusion. Economic valorization was performed from the French Social Insurance perspective, and a statistical modeling over 10 years was performed.
  
  
  
  In 341 patients, the mean total costs of management were &OV0556;6024 per year (&OV0556;4675 for direct costs). As compared to patients in remission, costs were 4 to 6 times higher in patients in an active period and 19 times higher for patients requiring surgery (SURG). The most important expense items were medical and surgical hospitalizations (56% of total costs), including cost of infliximab (36% of hospitalization costs, i.e., 20% of total costs), indirect costs (22%), and drugs (11%). The statistical modeling over 10 years showed that most of the clinical course was spent in drug-responsive state (54%) with 26% of costs or in remission (32%) with 11% of costs; time spent in a SURG state was small (3.2%) but generated 48% of total costs.
  
  
  
  Before the introduction of self-injectable anti-tumor necrosis factor alpha, the most important expenses were supported by hospitalizations, explaining why the most costly states were for patients requiring SURG or dependent on inhospital administrated drugs. Projected data show that most time is spent in a stabilized state with appropriate treatments or in remission, and that costs associated with SURG are high.
authors.affiliation: 1Service de Gastroentérologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; 2Université Claude Bernard Lyon 1, Lyon, France; 3Service de Gastroentérologie, Hôpital Lariboisière, AP-HP, Paris, France; 4Service de Gastroentérologie, American University of Beirut Medical Center, Beirut, Lebanon; 5Service de Gastroentérologie, Hôpital Claude Huriez, Lille, France; 6Service de Gastroentérologie, Hôpital Charles Nicolle, Rouen, France; 7Service de Gastroentérologie, Hôpital Haute-Pierre, Strasbourg, France; 8Institut des Maladies de l'Appareil Digestif, CHU de Nantes, CIC Inserm 1413, Université de Nantes, Nantes, France; 9Service de Gastroentérologie, Hôpital Robert Debré, Reims, France; 10Service de Gastroentérologie, CHU d'Amiens, Amiens, France; 11Service de Gastroentérologie, Hôpital de Rangueil, Toulouse, France; 12Service d'Hépatologie, AP-HP, Hôpital Saint-Antoine, Paris, France; 13Service de Gastroentérologie, Hôpital Beaujon, AP-HP, Clichy, France; 14Department of Gastroenterology, University Hospital of Liège, Liège, Belgium; and 15Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du tube Digestif, Service de Gastroentérologie, AP-HP, Hôpital Saint-Louis, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Boschetti
authors.forename: Stephane
authors.initials: S
authors.lastname: Nancey
authors.forename: Fady
authors.initials: F
authors.lastname: Daniel
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pariente
authors.forename: Eric
authors.initials: E
authors.lastname: Lerebours
authors.forename: Bernard
authors.initials: B
authors.lastname: Duclos
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourreille
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cadiot
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.forename: Jacques
authors.initials: J
authors.lastname: Moreau
authors.forename: Philippe
authors.initials: P
authors.lastname: Marteau
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: Edouard
authors.initials: E
authors.lastname: Louis
authors.forename: Bernard
authors.initials: B
authors.lastname: Flourié
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003424:Crohn Disease / Q000191:economics*; D005260:Female; D005602:France; D005765:Gastrointestinal Agents / Q000191:economics; D017048:Health Care Costs / Q000639:trends*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D000069285:Infliximab / Q000191:economics; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab