Studies conducted more than 15 years ago determined that the annual cost of Crohn’s disease in the United States exceeded $1 billion, with the largest proportion being direct medical costs.1,2 At that time (1999 to 2000), the use of biologic therapy to treat Crohn’s disease had not yet skyrocketed, and these figures are undoubtedly higher
By 2012, the economic burden of Crohn’s disease was found to be far greater. A retrospective study in Italy found that average direct annual costs associated with a cohort of patients with active disease were €11,838 per patient (approximately $16,000).3 Adding in productivity and other indirect costs raised this figure to €15,521 per year ($21,000), with direct costs representing 76% of the total. According to the Crohn’s and Colitis Foundation of America, 700,000 Americans may be affected by the disease,4 and the estimated direct cost for these patients is $1.84 billion.5
Hospitalizations account for most direct costs associated with Crohn’s disease. These are sometimes necessary to treat intestinal obstructions, particularly in patients with long-standing disease. Bowel resection to remove the obstruction can be associated with hospital stays of up to 1 week, with no guarantee that treatment will prevent future obstructions elsewhere in the intestine.
Much literature has been published regarding the expectation that biologic therapies would reduce hospitalizations as well as other medical costs, and that these medications would reduce the cost burden of illness, but so far, the results have been inconsistent. Although these new medications have been shown to reduce hospitalization and other medical resources, the data conflict on whether they are truly cost-effective from a societal viewpoint (when using a cost-effectiveness threshold of $100,000 per quality-adjusted life-year).6-8 D