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. 2016 Apr 21;11(4):e0142481.
doi: 10.1371/journal.pone.0142481. eCollection 2016.

Evolution of Costs of Inflammatory Bowel Disease over Two Years of Follow-Up

Mirthe E van der Valk  1 , Marie-Josée J Mangen  2 , Mirjam Severs  1 , Mike van der Have  1 , Gerard Dijkstra  3 , Ad A van Bodegraven  4   5 , Herma H Fidder  1 , Dirk J de Jong  6 , C Janneke van der Woude  7 , Mariëlle J L Romberg-Camps  5 , Cees H M Clemens  8 , Jeroen M Jansen  9 , Paul C van de Meeberg  10 , Nofel Mahmmod  11 , Andrea E van der Meulen-de Jong  12 , Cyriel Y Ponsioen  13 , Clemens Bolwerk  14 , J Reinoud Vermeijden  15 , Peter D Siersema  1 , Max Leenders  1 , Bas Oldenburg  1 ; COIN study group and the Dutch Initiative on Crohn and Colitis
Affiliations

Evolution of Costs of Inflammatory Bowel Disease over Two Years of Follow-Up

Mirthe E van der Valk et al. PLoS One. .

Abstract

Background: With the increasing use of anti-TNF therapy in inflammatory bowel disease (IBD), a shift of costs has been observed with medication costs replacing hospitalization and surgery as major cost driver. We aimed to explore the evolution of IBD-related costs over two years of follow-up.

Methods and findings: In total 1,307 Crohn's disease (CD) patients and 915 ulcerative colitis (UC) patients were prospectively followed for two years by three-monthly web-based questionnaires. Changes of healthcare costs, productivity costs and out-of-pocket costs over time were assessed using mixed model analysis. Multivariable logistic regression analysis was used to identify costs drivers. In total 737 CD patients and 566 UC were included. Total costs were stable over two years of follow-up, with annual total costs of €7,835 in CD and €3,600 in UC. However, within healthcare costs, the proportion of anti-TNF therapy-related costs increased from 64% to 72% in CD (p<0.01) and from 31% to 39% in UC (p < 0.01). In contrast, the proportion of hospitalization costs decreased from 19% to 13% in CD (p<0.01), and 22% to 15% in UC (p < 0.01). Penetrating disease course predicted an increase of healthcare costs (adjusted odds ratio (adj. OR) 1.95 (95% CI 1.02-3.37) in CD and age <40 years in UC (adj. OR 4.72 (95% CI 1.61-13.86)).

Conclusions: BD-related costs remained stable over two years. However, the proportion of anti-TNF-related healthcare costs increased, while hospitalization costs decreased. Factors associated with increased costs were penetrating disease course in CD and age <40 in UC.

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Conflict of interest statement

Competing Interests: i) MvdV has no competing interests, ii) MJJM research funding is partially supported by grants provided to UMCU by Pfizer, and declares fees paid by GSK to the institution for participating in model building and manuscript writing, iii) MS has no competing interests iv) MvdH has no competing interests v) AvB has acted as a consultant for AbbVie, Ferring, MSD, Tramedico and Vifor and received payments for lectures from AbbVie, Ferring, Pfizer and Takeda. vi) HF has acted as a consultant for Abbott. vii) DdJ has acted as a consultant for Synthon Netherlands and received payments for lectures from Abbott, Ferring and MSD. viii) GD has no competing interests. ix) JvdW has acted as a consultant for Abbott, Ferring, Shire and MSD and received payment for lectures from Abbott, Falk Pharma and MSD. x) MRC has no competing interests. xi) CC has no competing interests. xii) JM has acted as a consultant for Abbvie, MSD, Ferring and Falk and received payments for lectures for Abbvie and MSD. xiii) PvdM has no competing interests. xiv) NM has no competing inerests. xv) CYP has acted as a consultant for Abbott and received payments for lectures from Ferring and MSD. xvi) CB has no competing interests. xvii) RV has no competing interests. xviii) AvdM has acted as consultant for Abbott,MSD, Ferring and Dr. Falk and received payments for lectures from Abbott and MSD xix) PS has no competing interests. xx) ML has no competing interests. xxi) BO has acted as a consultant for Abbott, Takeda and MSD and received payment for lectures from Ferring, MSD and Abbvie. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Design of the COIN study.
Fig 2
Fig 2
A. Three-monthly total costs per average CD-patient over two-year follow up. B. Three-monthly total costs per average UC-patient over two-year follow up.
Fig 3
Fig 3
A. The proportion of healthcare costs for an average CD-patient over two-year follow up. B. The proportion of healthcare costs for an average UC-patient over two-year follow up.
See this image and copyright information in PMC

References

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