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DIRECT COSTS


It is concerning that drug access can be an issue in treatment decisions. Although Canada has universal health care, drugs are outside of the system in most provinces. Everyone may access physicians, specialists, emergency rooms and hospitals, but not everyone has the same opportunity for drug coverage. A study among children with IBD found that socioeconomic status played an important role: children from lower income households were more likely to be hospitalized, visit the emergency room, see their physician, and receive surgery.69


It


is speculated that the difference could be related to access to the most effective but also expensive medications, which may be easier to obtain via private drug plans of working parents versus public drug plans for families on social assistance.


key findings:


• Prescription drug costs have changed dramatically in the past ten years, due to increasing use of high-cost biologicals.


• Currently, prescription drugs for IBD cost about $521 million in Canada in 2012 (approximately $2,200 per person per year).


• There are dramatic differences between provinces in per-capita drug costs and in the percentage of drug costs that are borne by public versus private drug plans.


HOSPITALIZATIONS, SURGERIES AND PHYSICIAN VISITS


Canadian studies on inpatient costs include database studies in Manitoba and a national survey of members of the Crohn’s and Colitis Foundation of Canada.


Researchers in Manitoba checked health records for people who had been identified as having IBD over several time points, with the most recent data from 2005/6.70,71


Health records were


examined to determine the annual costs of hospitalizations, surgeries, physician visits and drugs. For these four items, people with IBD had an average of $3,896 in direct medical costs in 2005/6. This amount was twice that of people without IBD (matched for age and gender). CD was more expensive than UC ($4,232 versus $3,522). Although average costs were higher for people with CD, it seemed due to the fact that there were higher costs for the more ‘extreme’ CD cases.


The most expensive cases fell into four categories: people in their first year post-diagnosis ($6,611), those who were hospitalized overnight ($13,494), those who had surgery ($18,749), and those using infliximab ($31,440). As is typical in costing studies, a small minority of costly patients accumulated a disproportionate amount of cost – in the case of this study, 11% of IBD cases contributed to 56% of total costs.


As mentioned above, more recent data were used to estimate drug costs. Therefore, the costs due to drug therapy were removed from the total. The Manitoba study was essential for the estimation of inpatient hospitalization, outpatient hospitalization (same-day stays and procedures), and physician visits. After subtracting drug costs, the average cost for these three items was $2,260 in 2005/6, or $2,521 per person in 2012 dollars. Of this amount, 67% was due to hospitalization, 22% to doctor visits, and 10% to outpatient visits. Extrapolated to the 233,000 Canadians with IBD, the total cost for these items would be $587 million ($395 million for hospital inpatient, $132 million for physician visits, and $61 million for hospital outpatient).


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 49


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