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Scand J Gastroenterol. 2019 Apr;54(4):419-426. doi: 10.1080/00365521.2019.1591498. Epub 2019 Mar 24.

Long-term evolution of direct healthcare costs for inflammatory bowel diseases: a population-based study (2006-2015).

Author information

1
a Center for Crohn's and Colitis, Department of Gastroenterology , Kyung Hee University College of Medicine , Seoul , Republic of Korea.
2
b Department of Biostatistics , Yonsei University Wonju College of Medicine , Wonju , Republic of Korea.
3
c Department of Statistics Support , Medical Science Research Institute, Kyung Hee University Medical Center , Seoul , Republic of Korea.
4
d Department of Internal Medicine , Yonsei University Wonju College of Medicine , Wonju , Republic of Korea.

Abstract

Introduction: We explored the long-term evolution of direct healthcare costs for inflammatory bowel diseases (IBD) using a population-level database in a country with an escalating burden of IBD. Methods: We searched the database of the Korean National Health Insurance Claims, which covers more than 97% of the South Korean population. An IBD diagnosis was defined as the combination of a billing code for Crohn's disease (CD: K50.xx) or ulcerative colitis (UC: K51.xx) and at least one claim for IBD-specific drugs. Between 2006 and 2015, a total of 59,447 patients (CD: 17,677; UC: 41,770) were included. Results: The total and mean cost per capita increased significantly over time. In the last year of the study (2015), the cost for anti-tumor necrosis factor (TNF) therapy accounted for 68.8% (CD) and 48.8% (UC) of the total cost. Age at diagnosis (<20 years vs. ≥30 years) and anti-TNF use were independent predictors of increased total IBD cost. Anti-TNF therapy was the strongest predictor of high-cost outliers (designated as the top 20 percentile of the total costs) for IBD (OR: 160.4; 95% CI: 89.0-289.2). The mean cost among patients with newly diagnosed CD increased significantly over the 8-year follow-up period (p = .03), while costs associated with UC remained stable. Only medication costs increased significantly during the follow-up period for CD. Conclusions: Over the past 10 years, the increased usage of anti-TNF agents has been the key driver of IBD-related healthcare costs. Long-term cost-cutting strategies for patients with CD are warranted.

KEYWORDS:

Anti-tumor necrosis factor-alpha; cost and cost analysis; delivery of health care; inflammatory bowel diseases

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