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DIRECT COSTS INTRODUCTION


Direct costs are costs for resources that are offered by the Canadian public health care system. Typically, these include: hospitalizations, surgeries, emergency department visits, physician services, medications, laboratory tests and procedures, allied health care professional visits (for example, physiotherapist, occupational therapist, dietitian, chiropractor, massage therapist), social services (home health care, meal delivery, transit for handicapped, etc.), and long-term care (nursing homes, institutional care, etc.).


Currently, there is no cure for either CD or UC. People with IBD live with symptoms – usually at a milder level while in remission and at a more severe level during disease flares. Between 75-90% of patients are in remission at any given point in time.54


with IBD reported severe disease activity among 9% of people with UC and 11% of people with CD.55


A Canadian survey of people


Disease severity is important, because medical costs vary dramatically by severity; studies have shown that a minority of patients with severe disease incur the majority of costs.56,57,58,59


To manage their disease, people with IBD need ongoing medical care – they use physician visits, medications, and laboratory tests on a regular basis. Other health care professionals, especially dietitians, are also helpful. With increasing disease activity and flares, medications are increased and hospitalizations for surgery become common. People who have severe disease may require high levels of care, including home health care and (very rarely) institutional care.


There has been considerable research into the costs of disease, especially for CD. One limitation with this research is that prices and patterns of use for health care services reflect local health care systems and practices. While there can be considerable similarity across countries, the most reliable way to measure direct medical costs in Canada is to use research conducted in Canada.


PRESCRIPTION DRUGS


Many people with IBD require regular medications to control their disease. These medications must be taken all the time (even while in remission) to prevent IBD from flaring, and to keep their symptoms at a manageable level. During times of increasing symptoms and higher disease activity, most patients will require increased doses or additional medications to reduce symptoms, prevent complications, and return to remission.


For disease flares, corticosteroids are powerful drugs to control the immune system and induce remission. However, these drugs have long-term safety concerns, so it is not desirable to stay on these drugs for prolonged periods of time. For long-term control, people are treated with medications such as immune modifiers and 5-aminosalicylates to control their disease on an ongoing basis. More recently, new drugs called ‘biologicals’ became available for IBD. These drugs are made by live cells (hence the name ‘biologicals’) and are classified as anti-TNF drugs because they are directed against a molecule which promotes inflammation – tumour necrosis factor (TNF). They are used by people with moderately active to severe disease. They are much more expensive than conventional, older drugs, given the complicated way that they are produced, but they are also quite effective, especially for people who have responded well to other drugs. They have reduced the need for surgeries and hospitalizations; patients


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 47


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