Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Medical Department, Zealand University Hospital, Koege, Denmark.
J Crohns Colitis. 2020 Jan 1;14(1):53-63. doi: 10.1093/ecco-jcc/jjz096.
Inflammatory bowel disease [IBD], encompassing Crohn's disease [CD] and ulcerative colitis [UC], places a high burden on health care resources. To date, no study has assessed the combined direct and indirect cost of IBD in a population-based setting. Our aim was to assess this in a population-based inception cohort with 10 years of follow-up.
All incident patients diagnosed with CD or UC, 2003-2004, in a well-defined area of Copenhagen, were followed prospectively until 2015. Direct and indirect costs were retrieved from Danish national registries. Data were compared with a control population [1:20]. Associations between the costs and multiple variables were assessed.
A total of 513 (CD: 213 [42%], UC: 300 [58%]) IBD patients were included. No significant differences were found in indirect costs between CD, UC, and the control population. Costs for CD patients were significantly higher than those for UC regarding all direct expenditures (except for5-aminosalicylates [5-ASA] and diagnostic expenses). Biologics accounted for €1.6 and €0.3 million for CD and UC, respectively. The total costs amounted to €42.6 million. Only patients with extensive colitis had significantly higher direct costs (proctitis: €2273 [1341-4092], left-sided: €3606 [2354-5311], extensive: €4093 [2313-6057], p <0.001). No variables were significantly associated with increased total costs in CD or in UC patients.
In this prospective population-based cohort, direct costs for IBD remain high. However, indirect costs did not surpass the control population. Total costs were mainly driven by hospitalisation, but indirect costs accounted for a higher percentage overall, although these did decrease over time.
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炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC），给医疗保健资源带来了沉重负担。迄今为止，尚无研究在基于人群的环境中评估 IBD 的直接和间接总成本。我们的目的是在一个基于人群的发病队列中进行评估，该队列随访了 10 年。
在哥本哈根一个明确界定的地区，所有在 2003-2004 年被诊断为 CD 或 UC 的新发患者均进行前瞻性随访，直至 2015 年。直接和间接成本均从丹麦国家登记处获得。将数据与对照人群（1:20）进行比较。评估成本与多个变量之间的关联。
共纳入 513 例（CD：213 [42%]，UC：300 [58%]）IBD 患者。CD、UC 和对照人群之间的间接成本无显著差异。与 UC 相比，CD 患者的所有直接支出（除 5-氨基水杨酸 [5-ASA] 和诊断费用外）均显著更高。生物制剂分别占 CD 和 UC 的 160 万欧元和 30 万欧元。总成本为 4260 万欧元。仅广泛结肠炎患者的直接成本显著更高（直肠炎：2273 欧元[1341-4092]，左侧结肠炎：3606 欧元[2354-5311]，广泛性结肠炎：4093 欧元[2313-6057]，p <0.001）。在 CD 或 UC 患者中，没有任何变量与总费用的增加显著相关。
在这项前瞻性基于人群的队列研究中，IBD 的直接成本仍然很高。然而，间接成本并未超过对照人群。总成本主要由住院治疗驱动，但间接成本总体占比更高，尽管其占比随着时间的推移而下降。
