Skip to main content
SpringerLink
Log in

The New Economic Reality in the World of IBD

  • Chapter
  • First Online:
Inflammatory Bowel Disease

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

The treatment of inflammatory bowel diseases over a lifetime adds a considerable amount of costs to the total healthcare burden. There is disparity in the usage of healthcare dollars whereby a small percentage of patients account for a majority of the total direct costs. In the prebiologic era, most costs were due to hospitalizations and surgeries. Currently, pharmaceuticals may account for the most costs. Crohn’s patient with fistulas accrue higher treatment costs than patients with solely luminal disease. Indirect costs contribute to over ½ of overall costs, yet are not measured in most economic analyses. Medication costs for biological therapies are higher than that of traditional agents. However, these drugs may decrease utilization of high cost items such as surgeries and hospitalizations. The cost-effectiveness of the different biological agents in Crohn’s disease may differ between drugs over long-term use. More studies are needed before this can be confirmed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992;14:309–17.

    Article  PubMed  CAS  Google Scholar 

  2. Hay AR, Hay JW. Inflammatory bowel disease: medical cost algorithms. J Clin Gastroenterol. 1992;14:318–27.

    Article  PubMed  CAS  Google Scholar 

  3. Tan JJ, Tjandra JJ. Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum. 2007;50:576–85.

    Article  PubMed  Google Scholar 

  4. Ananthakrishnan AN, McGinley EL, Binion DG. Does it matter where you are hospitalized for inflammatory bowel disease? A nationwide analysis of hospital volume. Am J Gastroenterol. 2008;103:2789–98.

    Article  PubMed  Google Scholar 

  5. Hanauer SB, Cohen RD, Becker RV, Larson LR. Advances in the management of Crohn’s disease: economic and clinical potential of Infliximab. Clin Ther. 1998;20:1009–28.

    Article  PubMed  CAS  Google Scholar 

  6. Feagan BG, Vreeland MG, Larson LR. Annual cost of care for Crohn’s disease: a payor perspective. Am J Gastroenterol. 2000;95:1955–60.

    Article  PubMed  CAS  Google Scholar 

  7. Bassi A, Dodd S, Williamson P. Cost of illness of inflammatory bowel disease in the UK: a single centre retrospective study. Gut. 2004;53:1471–78.

    Article  PubMed  CAS  Google Scholar 

  8. Yu AP, Cabanilla LA, Wu EQ, Mulani PM, Chao J. The Costs of Crohn’s disease in the United States and other Western countries: a systematic review. Curr Med Res Opin. 2008;24:319–28.

    Article  PubMed  CAS  Google Scholar 

  9. Bickston SJ, Waters HC, Dabbous O, Tang BI, Rahman M. Administrative claims analysis of all-cause annual costs of care and resource utilization by age category for ulcerative colitis patients. J Manag Care Pharm. 2008;14:352–62.

    PubMed  Google Scholar 

  10. Cohen RD, Waters HC, Tang B, Rahman MI. Effects of fistula on healthcare costs and utilization for patients with Crohn’s disease treated in a managed care environment. Inflamm Bowel Dis. 2008;14:1707–14.

    Article  PubMed  Google Scholar 

  11. Kappelman MD, Rifas-Shiman SL, Porter CQ, Ollendorf DA, Sandler RS, Galanko JA, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135:1907–13.

    Article  PubMed  Google Scholar 

  12. Staff ME, Cohen HE. Drug topics red book. Montvale, NJ: Medical Economics; 2007.

    Google Scholar 

  13. Ollendorf DA, Lidsky L. Infliximab drug and infusion costs among patients with Crohn’s disease in a commercially-insured setting. Am J Ther. 2003;13:502–6.

    Article  Google Scholar 

  14. Adalimumab. National PBM Drug Monograph 2003 (updated 2004).

    Google Scholar 

  15. Certolizumab pegol. Caremark Speciality Pharmacy Services Monograph 2008.

    Google Scholar 

  16. Natalizumab. National PBM monograph December 2007.

    Google Scholar 

  17. Loftus Jr EV. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004;126:1504–17.

    Article  PubMed  Google Scholar 

  18. Blomqvist P, Ekborn A. Inflammatory bowel diseases: health care and costs in Sweden in 1994. Scand J Gastroenterol. 1997;32:1134–9.

    Article  PubMed  CAS  Google Scholar 

  19. Ferguson A, Sedgwick DM. Juvenile-onset inflammatory bowel disease: predictors of morbidity and health status in early adult life. J R Coll Physicians Lond. 1994;28:220–27.

    PubMed  CAS  Google Scholar 

  20. Campieri M, Gionchetti P, Belluzzi A, Brignola C, Torresan F, Tampieri M, et al. 5-Aminosalicylic acid suppositories in the management of ulcerative colitis. Dis Colon Rectum. 1989;32:398–9.

    Article  PubMed  CAS  Google Scholar 

  21. Feagan BG, Bala M, Yan S. Unemployment and disability in patients with moderately to severely active Crohn’s disease. J Clin Gastroenterol. 2005;39:390–95.

    Article  PubMed  Google Scholar 

  22. Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–9.

    Article  PubMed  CAS  Google Scholar 

  23. Lichtenstein GR, Yan S, Bala M. Remission in patients with Crohn’s disease is associated with improvement in employment and quality of life and a decrease in hospitalizations and surgeries. Am J Gastroenterol. 2004;99:91–6.

    Article  PubMed  Google Scholar 

  24. Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350:876–85.

    Article  PubMed  CAS  Google Scholar 

  25. Ananthakrishnan AN, Weber LR, Knox JF, Skaros S, Emmons J, Lundeen S, et al. Permanent work disability in Crohn’s disease. Am J Gastroenterol. 2008;103:154–61.

    Article  PubMed  Google Scholar 

  26. Blam ME, Stein RB, Lichtenstein GR. Integrating anti-tumor necrosis factor therapy in inflammatory bowel disease:current and futur perspectives. Am J Gastroenterol. 2001;96:1977–97.

    PubMed  CAS  Google Scholar 

  27. Goodman C, Gemmen E, Shah S. The burden of gastrointestinal diseases. Bethseda, MD: American Gastroenterological Association; 2001. p. 1–89.

    Google Scholar 

  28. Cohen RD, Larson LR, Roth JM, Becker RV, Mummert LL. The cost of hospitalization in Crohn’s disease. Am J Gastroenterol. 2000;95:524–30.

    Article  PubMed  CAS  Google Scholar 

  29. Bernstein CN, Papineau N, Zajaczkowski J, Rawsthorne P, Okrusko G, Blanchard JF. Direct hospital costs for patients with inflammatory bowel disease in a Canadian tertiary care university hospital. Am J Gastroenterol. 2000;95:677–83.

    Article  PubMed  CAS  Google Scholar 

  30. Bewtra M, Su C, Lewis JD. Trends in hospitalization rates for inflammatory bowel disease in the United States. Clin Gastroenterol Hepatol. 2007;5:597–601.

    Article  PubMed  Google Scholar 

  31. Nguyen GC, Tuskey A, Dassopoulas T, Harris ML, Brant SR. Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004. Inflamm Bowel Dis. 2007;13:1529–35.

    Article  PubMed  Google Scholar 

  32. Smyth CM, Picha SB, Rathore O. Increasing rates and changing patterns of hospital admissions for patients with inflammatory bowel disease in Ireland: 1996-2001. Ir J Med Sci. 2005;174:28–32.

    Article  PubMed  CAS  Google Scholar 

  33. Bernstein CN, Nabalamba A. Hospitalization, surgery, and readmission rates of IBD in Canada: a population-based study. Am J Gastroenterol. 2006;101:110–18.

    Article  PubMed  Google Scholar 

  34. Rubenstein JH, Chong RY, Cohen RD. Infliximab decreases resource use among patients with Crohn’s disease. J Clin Gastroenterol. 2002;35:151–56.

    Article  PubMed  CAS  Google Scholar 

  35. Harrison JR, Rubenstein JH, Leff AR, Cohen RD. A controlled trial of the impact of infliximab upon health care utilization, costs, and charges in patients with Crohn’s disease. Gastroenterology. 2003;124:A521.

    Article  Google Scholar 

  36. Rutgeerts P, Feagan BG, Lichtenstein GR. Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology. 2004;126:402–13.

    Article  PubMed  CAS  Google Scholar 

  37. Lichtenstein GR, Yan S, Bala M. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology. 2005;128:862–69.

    Article  PubMed  CAS  Google Scholar 

  38. Jewell D, Satsangi J, Lobo A. Infliximab use in Crohn’s disease: impact on health care resources in the UK. Eur J Gastroenterol Hepatol. 2005;17:1047–52.

    Article  PubMed  CAS  Google Scholar 

  39. Silverstein MD, Loftus EV, Sandborn WJ. Clinical course and costs of care for Crohn’s disease: Markov model analysis of a population-based cohort. Gastroenterology. 1999;117:49–57.

    Article  PubMed  CAS  Google Scholar 

  40. Briggs A, Gray A. Economic notes: using cost effectiveness information. BMJ. 2000;320:246.

    Article  PubMed  CAS  Google Scholar 

  41. National Institute of Clinical Excellence. Guideline on the use of orlistat for the treatment of obesity in adults. NICE techonology appraisal guidance 2000;22.

    Google Scholar 

  42. Dillon A. NICE Technology Appraisal Guidance 2002;40.

    Google Scholar 

  43. Thomas T, Cohen RD. Pharmacoeconomic considerations for inflammatory bowel disease in the era of biological therapies. Expert Rev Gastroenterol Hepatol. 2007;1:101–12.

    Article  PubMed  Google Scholar 

  44. Marshall JK, Blackhouse G, Goeree R. Clinical and economic assessment: infliximab for the treatment of Crohn’s disease. Canadian Coordinating Office for Health Technology Assessment. Technology Overview 2002;8.

    Google Scholar 

  45. Lindsay J, Punekar YS, Morris J, Chung-Faye G. Health-economic analysis: cost-effectiveness of scheduled maintenance treatment with infliximab for Crohn’s disease – modelling outcomes in active luminal and fistulizing disease in adults. Aliment Pharmacol Ther. 2008;28:76–87.

    Article  PubMed  CAS  Google Scholar 

  46. Kaplan GG, Hur C, Korzenik JR, Sands BE. Infliximab dose escalation vs. initiation of adalimumab for loss of response in Crohn’s disease: a cost-effectiveness analysis. Aliment Pharmacol Ther. 2007;26:1509–20.

    Article  PubMed  CAS  Google Scholar 

  47. Bodger K, Kikuchi T, Hughes D. Cost-effectiveness of biological therapy for Crohn’s disease: Markov cohort analyses incorporating United Kingdom patient-level cost data. Aliment Pharmacol Ther. 2009;30:265–74.

    Article  PubMed  CAS  Google Scholar 

  48. Irvine EJ, Feagan B, Rochon J. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn’s Relapse Prevention Trial Study Group. Gastroenterology. 1994;106:287–96.

    PubMed  CAS  Google Scholar 

  49. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305:160–4.

    Article  PubMed  CAS  Google Scholar 

  50. Ware Jr JE, Gandek B, Kosinski M, Aaronson NK, Apolone G, Brazier J, et al. he equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51:1167–70.

    Article  PubMed  Google Scholar 

  51. Drossman DA, Patrick DL, Mitchell CM. Health-related quality of life in inflammatory bowel disease: functional status and patient worries and concerns. Dig Dis Sci. 1989;34:1379–86.

    Article  PubMed  CAS  Google Scholar 

  52. Casellas F, Lopez-Vivancos J, Badia X, Vilaseca J, Malagelada JR. Impact of surgery for Crohn’s disease on health related quality of life. Am J Gastroenterol. 2000;95:177–82.

    Article  PubMed  CAS  Google Scholar 

  53. Drossman DA, Li Z, Leserman J, Patrick DL. Ulcerative colitis and Crohn’s disease health status scales for research and clinical practice. J Clin Gastroenterol. 1992;15:104–12.

    Article  PubMed  CAS  Google Scholar 

  54. Hjortswang H, Strom M, Almer S. Health-related quality of life in Swedish patients with ulcerative colitis. Am J Gastroenterol. 1998;93:2203–11.

    Article  PubMed  CAS  Google Scholar 

  55. Vidal A, Gomez-Gil E, Sans M, Portella M, Salamero M, Pique JM, et al. Health-related quality of life in inflammatory bowel disease patients: the role of psychopathology and personality. Inflamm Bowel Dis. 2008;14:977–83.

    Article  PubMed  Google Scholar 

  56. Graff LA, Walker JR, Lix L, Clara I, Rawsthorne P, Rogala L, et al. The relationship of inflammatory bowel disease type and activity to psychological functioning and quality of life. Clin Gastroenterol Hepatol. 2006;4:1491–501.

    Article  PubMed  Google Scholar 

  57. Sandborn WJ, Colombel JF, Enns R, Feagan BG, Hanauer SB, Lawrance IC, et al. Natalizumab induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2005;353:1912–25.

    Article  PubMed  CAS  Google Scholar 

  58. Feagan BG, Yan S, Bala M, Bao W, Lichtenstein GR. The effects of infliximab maintenance therapy on healthrelated quality of life. Am J Gastroenterol. 2003;98:2232–28.

    Article  PubMed  CAS  Google Scholar 

  59. van Balkom BP, Schoon EJ, Stockbrügger RW, Wolters FL, van Hogezand RA, van Deventer SJ, et al. Effects of anti-tumour necrosis factor alpha therapy on the quality of life in Crohn’s disease. Aliment Pharmacol Ther. 2002;16:1101–7.

    Article  PubMed  Google Scholar 

  60. Cadahia V, García-Carbonero A, Vivas S, Fuentes D, Niño P, Rebollo P, et al. Infliximab improves quality of life in the short-term in patients with fistulizing Crohn’s disease in clinical practice. Rev Esp Enferm Dig. 2004;96:369–74.

    Article  PubMed  CAS  Google Scholar 

  61. Colombel JF, Sandborn WJ, Rutgeerts P, Enns R, Hanauer SB, Panaccione R, et al. Adalimumab for mainten ance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology. 2007;132:52–65.

    Article  PubMed  CAS  Google Scholar 

  62. Loftus EV, Feagan BG, Colombel JF, Rubin DT, Wu EQ, Yu AP, et al. Effects of adalimumab maintenance therapy on health-related quality of life of patients with Crohn’s disease: patient-reported outcomes of the CHARM trial. Am J Gastroenterol. 2008;103:3132–41.

    Article  PubMed  Google Scholar 

  63. Schreiber S, Khaliq-Kareemi M, Lawrance IC, Thomsen O, Hanauer SB, McColm J, et al. PRECISE 2 Study Investigators. Maintenance therapy with certolizumab pegol for Crohn’s disease. N Engl J Med. 2007;357:239–50.

    Article  PubMed  CAS  Google Scholar 

  64. Rutgeerts P, Schreiber S, Feagan B, Keininger DL, O’Neil L, Fedorak RN, et al. Certolizumab pegol, a monthly subcutaneously administered Fc-free anti-TNFalpha, improves health-related quality of life in patients with moderate to severe Crohn’s disease. Int J Colorectal Dis. 2008;23:289–96.

    Article  PubMed  Google Scholar 

  65. Feagan BG, Sandborn WJ, Hass S, Niecko T, White J. Health-related quality of life during natalizumab maintenance therapy for Crohn’s disease. Am J Gastroenterol. 2007;102:2737–46.

    Article  PubMed  CAS  Google Scholar 

  66. Odes S, Vardi H, Friger M, Wolters F, Russel MG, Riis L, et al. European Collaborative Study on Inflammatory Bowel Disease. Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation. Gastroenterology. 2006;131:719–28.

    Article  PubMed  Google Scholar 

  67. Stark R, Konig HH, Leidl R. Costs of inflammatory bowel disease in Germany. Pharmacoeconomics. 2006;24:797–814.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medical Center, MC 4076, 5841 South Maryland Avenue, Chicago, IL, 60637, USA

    Russell D. Cohen

Authors
  1. Nanda Venu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Russell D. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Russell D. Cohen .

Editor information

Editors and Affiliations

  1. MC 4076, Sect. Of GE, Hepatol. & Nutr., Department of Medicine, University of Chicago Medical Center, S. Maryland Ave. 5841, Chicago, 60637, Illinois, USA

    Russell D. Cohen

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Venu, N., Cohen, R.D. (2011). The New Economic Reality in the World of IBD. In: Cohen, R. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-433-3_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-433-3_19

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-432-6

  • Online ISBN: 978-1-60327-433-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation