INTRODUCTION: Crohn’s disease (CD) is an inflammatory bowel disease characterized by chronic inflammation of the gut. As new treatments become available, analyses of the cost to healthcare systems, patients, and their caregivers incurred by CD are increasingly important. The aim of this systematic literature review (SLR) was to identify and summarize the costs and healthcare resource utilization associated with CD in Europe from a societal perspective.
AIMS & METHODS: An SLR was conducted to identify studies reporting healthcare resource use and direct and indirect costs associated with CD, published in English from 1 January 2012 to 22 June 2018. Literature searches were conducted using MEDLINE, Embase, EconLit, and the Cochrane library databases. Conference abstracts from the past 2 years were reviewed, and bibliographic lists of relevant SLRs were interrogated. Study selection was guided by prespecified inclusion and exclusion criteria. Currency values were adjusted using purchase price parity values and inflation data using EU28 values (OECD, 2019).
RESULTS: A total of 40 studies presenting resource use, productivity and/or cost data were identified. Twenty-seven studies reported healthcare resource use data, 23 studies assessed direct costs, and 15 studies estimated indirect costs/lost productivity, 3 of which specifically assessed caregiver economic burden. Various methodologies including prospective questionnaires, database claims analysis, surveys, observational studies, and randomized controlled trials were used to estimate the direct cost of CD. Medication use (n = 20) and hospitalizations (n = 15) were the most frequently reported resources. The proportion of patients hospitalized ranged from 9.3% in patients on a biologic to 66% in patients with perianal disease. In addition, the mean hospital length of stay ranged from 2 days reported for a patient population in which only 14% of patients presented with active disease to 23 days in a study of patients with perianal disease. Total annual direct costs per patient varied widely across Europe, ranging from €4639 for a newly diagnosed patient population in Italy to €24 374 for a Spanish patient population receiving 12 months of biologic treatment. Before the introduction of biologics, the main components of the direct cost of CD across European healthcare systems were related to surgery and hospitalizations: after the introduction of biologics, the main cost driver was that associated with anti-tumor necrosis factor (TNF) therapies. Indirect costs such as productivity loss, sick leave, travel expenses, and out of pocket expenses contributed between €665 and €7591 per patient per year to the economic burden of CD.
CONCLUSION: This systematic review indicates that the direct costs and healthcare resource use associated with CD present a considerable economic burden in Europe. Although surgery and hospitalizations can have a substantial impact on costs, more recent studies show that the cost of biologics is now the main cost driver in CD patients across Europe.
