Department of Medicine, Section of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
BioDrugs. 2000 Nov;14(5):331-44. doi: 10.2165/00063030-200014050-00005.
New biological medical therapies and innovative surgical approaches have revolutionised the care of patients with Crohn's disease. Until these innovations began to be utilised over the past decade, studies of the economics of Crohn's disease care were relatively scarce. Questions from both clinical and economic standpoints now arise over potential choices between medical and surgical approaches to patients with Crohn's disease. Initial economic studies suggested that the vast majority of costs in Crohn's disease were due to inpatient services and surgery. The large variance in cost data between patients resulted in a very small percentage of patients accounting for a disproportionately large percentage of the overall costs, with the bulk of costs, charges and reimbursements accrued by surgical cases. Studies suggest that surgery would need to result in a decreased utilisation of outpatient services in order to be 'cost-effective'. Evaluation of the clinical course of Crohn's disease suggests that the surgically-induced remission state is the longest remission state generally experienced by the patients, although sophisticated cost analysis fails to show enough of a remission benefit to offset the high costs associated with surgical procedures and post-operative convalescence. Bowel-sparing intestinal strictureplasty and minimally invasive laparoscopic surgeries have the potential to substantially decrease the costs associated with disease. These techniques need to be applied to a larger percentage of surgical Crohn's patients before the overall economic benefits can be fully assessed. Indirect costs and disability may account for most of the overall costs associated with Crohn's disease. Quality-of-life analyses have revealed that patients ill with Crohn's disease perform poorly, and the detrimental effects of medications or surgery may further increase disability in these patients. Future cost-utility studies may reveal the extent to which overall costs are affected by these issues. This review of the currently available literature on the economics of Crohn's disease suggests that medical therapy which can substantially reduce the utilisation of hospitalisations and surgery might be cost effective, even if the acquisition cost of the drug is high. However, broader application of specialised surgical techniques, together with the long post-operative remission state enjoyed by most Crohn's patients, may also offer a cost-effective long term approach to the disease. It is likely that both surgical and medical approaches will continue to be used in the treatment of Crohn's disease, with options for each patient being carefully considered on an individual basis.
新的生物医学治疗方法和创新的手术方法彻底改变了克罗恩病患者的治疗方式。在过去十年中，这些创新开始被应用之前，对克罗恩病护理经济学的研究相对较少。现在，从临床和经济的角度来看，出现了针对克罗恩病患者的医疗和手术方法的潜在选择问题。最初的经济研究表明，克罗恩病的绝大多数费用都与住院服务和手术有关。患者之间的成本数据差异很大，导致只有一小部分患者占总费用的不成比例的大比例，大部分费用、收费和报销都由手术病例产生。研究表明，手术需要减少门诊服务的利用，才能具有“成本效益”。对克罗恩病临床过程的评估表明，手术引起的缓解状态通常是患者经历的最长缓解状态，尽管复杂的成本分析未能显示出足够的缓解益处来抵消与手术程序和术后康复相关的高成本。保留肠道的肠狭窄成形术和微创腹腔镜手术有可能大大降低与疾病相关的成本。在全面评估整体经济效益之前，需要将这些技术应用于更大比例的手术克罗恩病患者。间接成本和残疾可能占克罗恩病相关总成本的大部分。生活质量分析表明，患有克罗恩病的患者表现不佳，药物或手术的不利影响可能会进一步增加这些患者的残疾程度。未来的成本效益研究可能会揭示这些问题对总体成本的影响程度。对目前关于克罗恩病经济学的文献的综述表明，能够显著减少住院和手术利用的药物治疗可能具有成本效益，即使药物的获取成本很高。然而，广泛应用专门的手术技术，以及大多数克罗恩病患者享受的长期术后缓解状态，也可能为该疾病提供一种具有成本效益的长期方法。在治疗克罗恩病时，很可能会继续使用手术和医疗方法，并且会根据患者的具体情况仔细考虑每种方法的选择。
