Institute of Social and Preventive Medicine [IUMSP], Lausanne University Hospital, Lausanne, Switzerland.
Centre for Health Economics, University of York, York, UK.
J Crohns Colitis. 2019 May 27;13(6):744-754. doi: 10.1093/ecco-jcc/jjz003.
Inflammatory bowel disease [IBD] places an economic strain on health systems due to expensive pharmaceutical therapy, risk of hospitalisation and surgery, and long-term monitoring. The evolving treatment guidelines advocate rapid scale-up to biologic agents in order to improve health outcomes and quality of life. This study evaluated changes in health care utilisation and expenditures for IBD in Switzerland over time.
We extracted clinical, patient, and resource consumption data from the Swiss IBD Cohort Study between 2006 and 2016. Average unit costs for IBD-related events were derived from Swiss claims data and pharmaceutical price lists. We used multivariate regression, controlling for patient-level characteristics, to estimate trends and determinants of direct and indirect costs and resource utilisation.
We included 2365 adults diagnosed with Crohn's disease [CD; N = 1353] and ulcerative colitis [UC; N = 1012]. From 2006-16, mean health care expenditures per patient per year were 9504 euros [70% drugs, 23% inpatient, 7% outpatient] for CD and 5704 euros [68% drugs, 22% inpatient, 10% outpatient] for UC. Health care costs increased by 7% [CD] and 10% [UC] per year, largely due to rising pharmaceutical expenditures driven by increased biologic agent use. Inpatient, outpatient, and indirect costs fluctuated and did not offset increased pharmaceutical costs. Disease characteristics were important predictors of costs.
Increased expenditure for IBD was marked by a shift towards greater pharmaceutical management over the past decade. This study highlights the need to identify cost-effective treatment strategies in the face of increased uptake and expenditures associated with innovative treatments.
炎症性肠病（IBD）由于昂贵的药物治疗、住院和手术风险以及长期监测，给卫生系统带来了经济压力。不断发展的治疗指南主张迅速扩大生物制剂的使用范围，以改善健康结果和生活质量。本研究评估了瑞士 IBD 患者的医疗保健利用和支出随时间的变化。
我们从 2006 年至 2016 年的瑞士 IBD 队列研究中提取了临床、患者和资源消耗数据。IBD 相关事件的平均单位成本来自瑞士索赔数据和药品价格清单。我们使用多变量回归，控制患者水平的特征，来估计直接和间接成本以及资源利用的趋势和决定因素。
我们纳入了 2365 名诊断为克罗恩病（CD；N=1353）和溃疡性结肠炎（UC；N=1012）的成年人。2006-16 年，每位患者每年的平均医疗保健支出为 9504 欧元（70%为药物，23%为住院，7%为门诊）用于 CD，5704 欧元（68%为药物，22%为住院，10%为门诊）用于 UC。医疗保健费用每年增长 7%（CD）和 10%（UC），主要是由于生物制剂使用增加导致药物支出增加。住院、门诊和间接费用波动，没有抵消药物成本的增加。疾病特征是成本的重要预测因素。
在过去十年中，IBD 的支出增加主要表现为药物管理的增加。本研究强调了在面临与创新治疗相关的更高利用率和支出的情况下，需要确定具有成本效益的治疗策略。
