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SUMMARY, CHALLENGES AND RECOMMENDATIONS


INTERNATIONAL COMPARISON OF IBD COSTS


It can be useful to compare Canadian costs of IBD to the costs in other countries. However, there can be large differences in the costs that are reported, for many different reasons. First, total costs depend on the total number of individuals with IBD. Greater numbers of individuals with IBD mean greater costs. Canada has one of the highest prevalence of IBD in the world, so Canadian costs might be expected to be high. Second, different researchers will use different methods and data to determine costs. Depending on the accuracy of the data, and the types of costs that are included, results may not be directly comparable across countries. Third, prices of items can differ between countries. For expensive items like hospitalization, this would have an impact. Finally, the timing of the research is important, as we know that there have been dramatic shifts over time – with increasing drug costs and declining surgery/hospitalization costs. Recall that Canadian direct costs for this report were estimated at $5,200 per person with IBD, using data from 2005/6 for most medical costs, with 2011 data for drug costs.


American researchers used large administrative databases to examine the direct medical costs incurred by people with IBD versus those without IBD.141


There were about 20,000


people with IBD in the study – a large sample. The difference in annual cost between these two groups was assumed to be the amount attributable to IBD. Using data from 2003/4, they determined that per-person mean annual costs were US$8,265 for CD and US$5,066 for UC (2004 US$). CD costs were equally split between pharmaceutical claims (35%), outpatient care (33%) and hospitalization (31%). UC costs were weighted more to hospitalization (38%) and outpatient care (37%) than pharmaceuticals (27%, perhaps because biologicals were less used for UC at that time). Compared to earlier research, hospitalization costs have decreased from 55% to 31% for CD, with a corresponding increase in drug costs from 4% to 35%.142,143 A striking finding was that IBD costs were significantly higher for children under 20 compared to adults. Drug costs were not so different between children and adults, but hospitalizations and outpatient services were higher for children. Given that there were just under 1 million Americans with IBD at the time of the research, IBD-attributable annual direct costs were estimated at $6.3 billion.


A recent German study looked at the database records in 2006/7 for about 1,000 people with IBD at gastroenterologist practices.144


Average annual direct medical costs were €3,767 for


CD (CDN$4,859) and €2,478 for UC (CDN$3,197). Use of biologicals, inpatient stays, gender and severity status all had a significant influence on costs. The vast majority of costs were for pharmaceuticals (68% for CD and 74% for UC).


Crohn’s and Colitis Australia conducted a comprehensive report on the costs of IBD in Australia in 2007.145


Unlike the situation in Canada, they did not have reliable Australian data


on prevalence of IBD, which was an important limitation. They determined that there were approximately 61,000 individuals with IBD in Australia (with a population of about 20 million, this is a prevalence of 0.3%). For these individuals, the total cost (direct plus indirect) was $406 million – or approximately $6,600 per individual with IBD.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 81


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