Kamat Nagesh, Ganesh Pai C, Surulivel Rajan M, Kamath Asha
Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, 576104, India.
Department of Pharmacotherapy, UNTS College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA.
Dig Dis Sci. 2017 Sep;62(9):2318-2326. doi: 10.1007/s10620-017-4690-z. Epub 2017 Aug 1.
Frequent relapses sometimes necessitating hospitalization and the absence of pharmacological cure contribute to substantial healthcare costs in inflammatory bowel diseases (IBDs). The costs of health care in Indian patients with IBD are unknown.
To evaluate the annual costs for treating Crohn's disease and ulcerative colitis.
A prevalence-based, micro-costing method was used to assess the components of annual costs in a prospective, observational study conducted in a tertiary healthcare center enrolled over a 24-month period beginning of July 2014.
At enrollment, 43/59 (72.88%) patients with UC and 18/25 (72%) with CD were in remission. The annual median (IQR) cost per UC and CD patient in remission was INR 43,140 (34,357-51,031) [USD $707 (563-836)] and INR 43,763.5 (32,202-57,372) [USD $717 (527-940)], respectively, and in active disease was INR 52,436.5 (49,229-67,567.75) [$859 (807-1107)] and INR 72,145 (49,447-92,212) [USD $1182 (811-1512)], respectively. Compared with remission, active disease had a 1.4-fold higher cost for CD as compared to UC. In both groups, the greatest component of direct costs was drugs. Thirteen (22%) and 7 (28%) patients with UC and CD needed hospitalization accounting for 23.1 and 20.4% of the total costs, respectively. At one year, direct costs surmounted indirect costs in UC and CD (p < 0.001). Productivity losses contributed to 18.5 and 16% of the overall costs for UC and CD, respectively.
This first, panoptic, health economic study for IBD from India shows that the costs are driven by medication, productivity losses, and not merely hospitalization alone.
炎症性肠病（IBD）频繁复发有时需要住院治疗，且缺乏药物治愈方法，导致医疗成本大幅增加。印度IBD患者的医疗费用尚不清楚。
评估治疗克罗恩病和溃疡性结肠炎的年度费用。
在一家三级医疗中心于2014年7月开始的为期24个月的前瞻性观察研究中，采用基于患病率的微观成本核算方法评估年度费用的组成部分。
入组时，59例溃疡性结肠炎（UC）患者中有43例（72.88%）、25例克罗恩病（CD）患者中有18例（72%）处于缓解期。缓解期UC和CD患者的年度中位数（四分位间距）费用分别为43,140印度卢比（34,357 - 51,031）[707美元（563 - 836）]和43,763.5印度卢比（32,202 - 57,372）[717美元（527 - 940）]，活动期疾病患者的费用分别为52,436.5印度卢比（49,229 - 67,567.75）[859美元（807 - 1107）]和72,145印度卢比（49,447 - 92,212）[1182美元（811 - 1512）]。与缓解期相比，CD活动期疾病的费用比UC高1.4倍。在两组中，直接成本的最大组成部分是药物。13例（22%）UC患者和7例（28%）CD患者需要住院治疗，分别占总费用的23.1%和20.4%。一年时，UC和CD的直接成本超过间接成本（p < 0.001）。生产力损失分别占UC和CD总体费用的18.5%和16%。
这项来自印度的关于IBD的首次全面卫生经济学研究表明，费用是由药物、生产力损失驱动的，而不仅仅是住院治疗。
