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OP09. Anti TNF‑α therapy is a major cost driver in inflammatory bowel disease: Results from the COIN study


M. Van der Valk1, M.‑J. Mangen2, G. Dijkstra3, A. van Bodegraven4, H. Fidder5, D. de Jong6, M. Pierik7, C.J. van der Woude8, M. Romberg-Camps9, C. Clemens10, J. Jansen11, P. van de Meeberg12, N. Mahmmod13, C. Ponsioen14, C. Rogge-Wolf15, R. Vermeijden16, P. Siersema1, M. Van Oijen1, B. Oldenburg17

1University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands; 2University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands; 3University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands; 4VU University Medical Center, Gastroenterology, Amsterdam, Netherlands; 5University Medical Center Utrecht, Department of Gastroenterology, Utrecht, Netherlands; 6Universitair Medisch Centrum St Radboud, Afd Maag–Darm Leverziekten, Nijmegen, Netherlands; 7Maastricht University Medical Center, Dept of Gastroenterology, Maastricht, Netherlands; 8Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands; 9Orbis Medical Center, Gastroenterology and Hepatology, Sittard, Netherlands; 10Diaconessenhuis, Gastroenterology and Hepatology, Leiden, Netherlands; 11Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, Netherlands; 12Slingeland Hospital, Gastroenterology and Hepatology, Doetinchem, Netherlands; 13Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands; 14Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, Netherlands; 15Reinier de Graaf Gasthuis, Gastroenterology and Hepatology, Delft, Netherlands; 16Meander Medical Center, Gastroenterology and Hepatology, Amersfoort, Netherlands; 17University Medical Centre Utrecht, Department of Gastroenterology, Utrecht, Netherlands



Background: Inflammatory bowel disease (IBD) is associated with a high economic burden to society. It has been estimated that up to two third of the total costs of IBD are generated by productivity loss. Most costs studies, however, have been performed before the introduction of the effective but costly biological therapies. In the present study, we therefore aimed to assess the total costs of IBD in a large cohort of IBD patients and to identify the main cost drivers.

Methods: Between October 1, 2010 and June 1, 2011 a total of 10,947 patients with IBD were invited to participate in the COIN study and to fill out a web-based questionnaire every 3 months during 2 years of follow up. The questionnaires included questions on demographics, healthcare costs (visits to outpatient clinic, diagnostic procedures, hospitalization, surgery and medication use) and productivity costs (work days lost due to sick leave). Costs were calculated by multiplying resource use by the unit costs as determined by the Dutch pharmaco-economic guideline by Oostenbrink et al.

Results: A total of 2,554 patients completed both the baseline as well as 3 months of follow-up questionnaires, of which 1,304 (51%) reported to suffer from Crohn's disease (CD), 928 (36%) patients from ulcerative colitis (UC), and 322 (13%) had unspecified type of IBD. In CD the mean total costs in 3 months were €1,738, of which €1,468 (84%) were healthcare costs and €270 (16%) productivity costs. For UC costs were significantly lower (€896 total costs, €553 (60%) healthcare costs, €363 (40%) productivity costs). Overall, the single most expensive resource was medication use, mainly due to prescription of anti-TNF‑α therapy accounting for an average of €1,044 (71%) in CD patients and €186 (33%) in UC patients. Furthermore, 10% of the high-cost patients accounted for 40% of the total health care costs in CD and 59% in UC, respectively.

Conclusions: The traditional cost profile in IBD has changed and health care costs are now even more driven by medication costs, most importantly due to anti-TNF‑α therapy. Whether this is balanced by a decrease in surgery and hospital admission-related costs as suggested by recent studies, and/or resulting in a reduction of sick leave and work disability will be assessed in follow-up studies.