The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs

M Ellen Kuenzig^{1

2}, Stephanie Coward³, Laura E Targownik⁴, Sanjay K Murthy^{5

6}, Eric I Benchimol^{1

2

7

8

9}, Joseph W Windsor³, Charles N Bernstein^{10

11}, Alain Bitton¹², Jennifer L Jones¹³, Kate Lee¹⁴, Juan-Nicolás Peña-Sánchez¹⁵, Noelle Rohatinsky¹⁶, Sara Ghandeharian¹⁴, James H B Im^{1

2}, Rohit Jogendran¹⁷, Saketh Meka¹⁸, Jake Weinstein^{1

2}, Tyrel Jones May¹⁹, Manisha Jogendran²⁰, Sahar Tabatabavakili²¹, Elias Hazan²², Malini Hu¹⁷, Jessica Amankwah Osei¹⁵, Rabia Khan^{1

2

7}, Grace Wang¹⁷, Mira Browne^{1

2}, Tal Davis^{1

2}, Quinn Goddard³, Julia Gorospe³, Kate Latos¹⁴, Kate Mason¹⁴, Jack Kerr²³, Naji Balche¹³, Anna Sklar¹³, Gilaad G Kaplan³

Affiliations

¹ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
³ Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁴ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
⁷ ICES, Toronto, Ontario, Canada.
⁸ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁹ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹¹ University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
¹² Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada.
¹³ Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁴ Crohn's and Colitis Canada, Toronto, Ontario, Canada.
¹⁵ Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁶ College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁷ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Department of Neuroscience, McGill University, Montreal, Quebec, Canada.
¹⁹ Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
²⁰ Department of Medicine, Queen's University, Kingston, Ontario, Canada.
²¹ Department of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.
²² Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada.
²³ Department of Medicine, Memorial University of Newfoundland, St John's Newfoundland, Canada.

PMID: 37674493
PMCID: PMC10478805
DOI: 10.1093/jcag/gwad008

Review

The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs

M Ellen Kuenzig et al. J Can Assoc Gastroenterol. 2023.

. 2023 Sep 5;6(Suppl 2):S23-S34.

doi: 10.1093/jcag/gwad008. eCollection 2023 Sep.

Authors

Affiliations

¹ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
³ Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁴ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
⁷ ICES, Toronto, Ontario, Canada.
⁸ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁹ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹¹ University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
¹² Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada.
¹³ Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁴ Crohn's and Colitis Canada, Toronto, Ontario, Canada.
¹⁵ Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁶ College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁷ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Department of Neuroscience, McGill University, Montreal, Quebec, Canada.
¹⁹ Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
²⁰ Department of Medicine, Queen's University, Kingston, Ontario, Canada.
²¹ Department of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.
²² Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada.
²³ Department of Medicine, Memorial University of Newfoundland, St John's Newfoundland, Canada.

PMID: 37674493
PMCID: PMC10478805
DOI: 10.1093/jcag/gwad008

Abstract

Healthcare utilization among people living with inflammatory bowel disease (IBD) in Canada has shifted from inpatient management to outpatient management; fewer people with IBD are admitted to hospitals or undergo surgery, but outpatient visits have become more frequent. Although the frequency of emergency department (ED) visits among adults and seniors with IBD decreased, the frequency of ED visits among children with IBD increased. Additionally, there is variation in the utilization of IBD health services within and between provinces and across ethnocultural and sociodemographic groups. For example, First Nations individuals with IBD are more likely to be hospitalized than the general IBD population. South Asian children with Crohn's disease are hospitalized more often than their Caucasian peers at diagnosis, but not during follow-up. Immigrants to Canada who develop IBD have higher health services utilization, but a lower risk of surgery compared to individuals born in Canada. The total direct healthcare costs of IBD, including the cost of hospitalizations, ED visits, outpatient visits, endoscopy, cross-sectional imaging, and medications are rising rapidly. The direct health system and medication costs of IBD in Canada are estimated to be $3.33 billion in 2023, potentially ranging from $2.19 billion to $4.47 billion. This is an increase from an estimated $1.28 billion in 2018, likely due to sharp increases in the use of biologic therapy over the past two decades. In 2017, 50% of total direct healthcare costs can be attributed to biologic therapies; the proportion of total direct healthcare costs attributed to biologic therapies today is likely even greater.

Keywords: Crohn’s disease; Direct costs; Health services utilization; Ulcerative colitis.

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Conflict of interest statement

Ellen Kuenzig is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Laura Targownik has received research funding from AbbVie Canada, Takeda Canada, Sandoz Canada, Amgen Canada, Gilead Canada, Roche Canada and Pfizer Canada and has been on Advisory Boards for Janssen Canada, AbbVie Canada, Takeda Canada, Pfizer Canada, Merck Canada, Roche Canada, Sandoz Canada, Organon Canada, Fresesnius Kabi Canada, Eli Lilly Canada and Amgen Canada. She is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Sanjay Murthy has previously participated in advisory board meetings for AbbVie, Janssen, Takeda, Pfizer, Shire and Ferring and as a speaker at educational events sponsored by Janssen, AbbVie and Pfizer. Eric Benchimol holds the Northbridge Financial Corporation Chair in Inflammatory Bowel Disease, a joint Hospital-University Chair between the University of Toronto, The Hospital for Sick Children, and the SickKids Foundation. He has acted as a consultant for the Dairy Farmers of Ontario and McKesson Canada for matters unrelated to medications used to treat inflammatory bowel disease. He is the Past Chair of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada and Editor-in-Chief of the Journal of the Canadian Association of Gastroenterology (JCAG). Charles Bernstein is supported in part by the Bingham Chair in Gastroenterology. He is on Advisory Boards for AbbVie Canada, Amgen Canada, Bristol Myers Squibb, JAMP Pharmaceuticals, Lilly Canada, Janssen Canada, Pfizer Canada, Roche Canada, Sandoz Canada, Takeda Canada. He is a Consultant for Mylan Pharmaceuticals and Takeda. He has received educational grants from AbbVie Canada, Pfizer Canada, Takeda Canada, Janssen Canada and Bristol Myers Squibb Canada. He is on the speaker’s panel for AbbVie Canada, Janssen Canada, Pfizer Canada and Takeda Canada. Received research funding from AbbVie Canada, Amgen Canada, Pfizer Canada, Sandoz Canada. Alain Bitton has participated in advisory boards with AbbVie, Janssen, Takeda, McKesson, BioJamp, Bristol Myers Squibb Hoffman-LaRoche, Amgen. He has received research support from AbbVie. He is on the speaker’s panel for Janssen, Takeda, AbbVie and has participated in educational activities supported by Viatris, and has received educational support from Fresenius Kabi, Amgen and Takeda. Jennifer Jones has received honoraria for speaking and consulting for AbbVie, Janssen, Pfizer, Shire and Takeda. She is the co-chair of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Kate Lee has received honoraria from AbbVie Corporation and Bristol Myers Squibb Canada. Kate Latos has received an AbbVie IBD scholarship. Kate Mason has received an AbbVie IBD scholarship. Gilaad Kaplan has received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer and Takeda. He has received research support from Ferring, Janssen, AbbVie, GlaxoSmith Kline, Merck and Shire. He has been a consultant for Gilead. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. 7 Sept. 2018. He is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. None: Stephanie Coward, Joseph Windsor, Juan-Nicolás Peña-Sánchez, Noelle Rohatinsky, Sara Ghandeharian, James Im, Rohit Jogendran, Saketh Meka, Jake Weinstein, Tyrel Jones May, Manisha Jogendran, Sahar Tabatabavakili, Elias Hazan, Malini Hu, Jessica Amankwah Osei, Rabia Khan, Grace Wang, Mira Browne, Tal Davis, Quinn Goddard, Julia Gorospe, Jack Kerr, & Anna Sklar.

References

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The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs

Affiliations

The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources

Miscellaneous