Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up : a population-based study

Copyright © 2020 Elsevier Ltd. All rights reserved..

BACKGROUND: Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up.

METHODS: The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery.

FINDINGS: The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001).

INTERPRETATION: Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease.

FUNDING: Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.

Media Type:

Electronic Article

Year of Publication:


Contained In:

The lancet. Gastroenterology & hepatology - Vol. 5, No. 5 (2020), p. 454-464




Burisch, Johan
Vardi, Hillel
Schwartz, Doron
Friger, Michael
Kiudelis, Gediminas
Kupčinskas, Juozas
Fumery, Mathurin
Gower-Rousseau, Corinne
Lakatos, Laszlo
Lakatos, Peter L
D'Incà, Renata
Sartini, Alessandro
Valpiani, Daniela
Giannotta, Martina
Arebi, Naila
Duricova, Dana
Bortlik, Martin
Chetcuti Zammit, Stefania
Ellul, Pierre
Pedersen, Natalia
Kjeldsen, Jens
Midjord, Jóngerð Maria Miné
Nielsen, Kári Rubek
Winther Andersen, Karina
Andersen, Vibeke
Katsanos, Konstantinos H
Christodoulou, Dimitrios K
Domislovic, Viktor
Krznaric, Zeljko
Sebastian, Shaji
Oksanen, Pia
Collin, Pekka
Barros, Luisa
Magro, Fernando
Salupere, Riina
Kievit, Hendrika Adriana Linda
Goldis, Adrian
Kaimakliotis, Ioannis P
Dahlerup, Jens F
Eriksson, Carl
Halfvarson, Jonas
Fernandez, Alberto
Hernandez, Vicent
Turcan, Svetlana
Belousova, Elena
Langholz, Ebbe
Munkholm, Pia
Odes, Selwyn
Epi-IBD group
Turk, Niksa
Cukovic-Cavka, Silvija
Nicolaou, Anastasia
Lukas, Milan
Shonová, Olga
Blichfeldt, Birgitte
Marker, Dorte
Carlsen, Katrine
Weimers, Petra
Aalykke, Clays
Kudsk, Karen
Vind, Ida
Thorsgaard, Niels
Skamnelos, Alexandros
Politis, Dimitrios
Vegh, Zsuzsanna
Demenyi, Peterne
Nemethne Kramli, Szabina
Dal Piaz, Giualia
Santini, Alessia
Girardin, Giulia
Kupcinskas, Limas
Jonaitis, Laimas
Valantiene, Irena
Zykus, Romanas
Kucinskiene, Ruta
Lazar, Daniela
Nikulina, Inna
de Castro, Luisa
Pineda, Juan-Ramon
Pereira, Santos
Martinez-Cadilla, Jesus
Sanroman, Luciano
Figueira, Montserrat
Ares, David Martinez
Rodriguez-Prada, Jose-Ignacio
Carmona, Amalia
Gonzalez-Portela, Carlos
Widen, Ulla-Britt
Myers, Sally
Ashton, Katherine
Whitehead, Emma




Biological Products
Colitis, Ulcerative
Crohn Disease
Diagnostic Techniques and Procedures
Digestive System Surgical Procedures
Follow-Up Studies
Health Care Costs
Journal Article
Middle Aged
Prospective Studies
Research Support, Non-U.S. Gov't


Date Completed 20.07.2020

Date Revised 20.07.2020

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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