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INTRODUCTION


Literature Review


For each section of this report, an extensive literature review was conducted to obtain the most recent and relevant research. Wherever possible, Canadian-based data and research were used. Scientific publications were the most important source for data. The scientific literature was searched using key words such as IBD, CD or UC plus costing, quality of life, or epidemiology. There was a focus on retrieving work that was set in Canada. Published literature was supplemented, where appropriate, by the expertise and unpublished research of the Steering Committee members.


Additional data sources were also used where appropriate. For example, information on the costs of prescriptions was obtained from electronic databases of prescription drug claims from insurance plans. Websites were also used, such as the Statistics Canada website to track the census population of Canada.


Strong and robust research has been conducted in Canada with respect to epidemiology, utilization of health care resources, productivity, patient costs, and quality life. On occasion, it was necessary to use non-Canadian research to supplement locally-derived data.


Analysis


Information from the various data sources was combined and converted into a burden of illness summary. First, it was necessary to determine best estimates for important factors, such as: the current number of individuals with IBD in Canada, the average per-person cost for medications and hospitalizations, and the average per-person costs in lost productivity. Where there was one particularly strong information source, it was used to generate the best estimate. For example, a landmark study has been published reporting on the number of people with IBD in Canada; this study was used as the primary data source for this factor. Where there were a number of different information sources, with differing results, the data were combined using statistical techniques to determine a best estimate. For example, there were ten different studies reporting international experiences of premature mortality with CD; these data were combined statistically to calculate a single best estimate of mortality risk.


Second, it was necessary to attach prices or costs to the amount of resources that are used for IBD. For example, studies would estimate the average number of hospitalizations or the average amount of lost productivity per person. This was multiplied by the total number of people with CD or UC to determine the total amount of resource utilization. Then, prices were determined for each element such as the cost of a hospitalization or physician visit, or the average wage rate. These prices were determined from public sources. Costs for health care resources were determined primarily from the Ontario health care system. Productivity losses were priced using the Canadian average wage rate as reported by Statistics Canada.


Costs were summed for a national total, but were also broken down by disease (CD versus UC) and by province.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 14


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