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OP008. The cost of investigations and medical treatment including biological therapy in a European inception cohort from the biological era - An ECCO-EpiCom study

J. Burisch1, I. Kaimakliotis2, D. Duricova3, N. Thorsgaard4, V. Andersen5,6,7, K.R. Nielsen8, E.V. Tsianos9, K. Ladefoged10, Y. Bailey11, R. D'Incà12,13, L. Kupcinskas14, S. Turcan15, F. Magro16,17,18, A. Goldis19, E. Belousova20, V. Hernandez21, S. Almer22,23, J. Halfvarson24,25, S. Sebastian26, E. Langholz27, S. Odes28, P. Munkholm1, 1Herlev University Hospital, Department of Gastroenterology, Herlev, Denmark, 2Nicosia private practice, Private practice, Nicosia, Cyprus, 3Charles University, IBD Center ISCARE, Prague, Czech Republic, 4Herning Central Hospital, Department of medicine, Herning, Denmark, 5Viborg Regional Hospital, Medical Department, Viborg, Denmark, 6University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark, 7Hospital of Southern Jutland, Medical Department, Aabenraa, Denmark, 8The National Hospital of the Faroe Islands, Medical Department, Thorshavn, Faroe Islands, 9University Hospital, Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 10Dronning Ingrids Hospital, Medical Department, Nuuk, Greenland, 11Adelaide and Meath Hospital, TCD, Department of Gastroenterology, Dublin, Ireland, 12Azienda Ospedaliera, Università di Padova, UO Gastroenterologia, Padova, Italy, 13On behalf of the EpiCom Northern Italy centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Northern Italy, Italy, 14Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 15State University of Medicine and Pharmacy of the Republic of Moldova, Department of Gastroenterology, Chisinau, Moldova, Republic of, 16Oporto Medical School, Institute of Pharmacology and Therapeutics, Porto, Portugal, 17Hospital de São João, Department of Gastroenterology, Porto, Portugal, 18University of Porto, Institute for molecular and cell biology, Porto, Portugal, 19University of Medicine ‘Victor Babes’, Clinic of Gastroenterology, Timisoara, Romania, 20Moscow Regional Research Clinical Institute, Department of Gastroenterology, Moscow, Russian Federation, 21Complejo Hospitalario Universitario de Vigo, Gastroenterology, Vigo, Spain, 22County council of Östergötland, Department of Gastroenterology/UHL, Linköping, Sweden, 23Karolinska Institutet, Division of Gastroenterology and Hepatology, Stockholm, Sweden, 24Örebro University, School of Health and Medical Sciences, Örebro, Sweden, 25Örebro University Hospital, 24. Department of Medicine, Division of Gastroenterology, Örebro, Sweden, M, 26Hull Royal Infirmary, Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull, United Kingdom, 27Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark, 28Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel

Background

Data on the cost of inflammatory bowel disease (IBD) care in population-based cohorts are available for several Western European countries, but represent the era preceding widespread use of biological therapy. The aim of this study was to assess the costs of investigations and treatment during the first year following diagnosis in Eastern and Western Europe.

Methods

The EpiCom-cohort is a European prospective population-based cohort of unselected, uniformly diagnosed patients with IBD diagnosed in 2010 in 31 centres from 14 Western and 8 Eastern European countries, covering 10 million in background population [1]. Patients are followed every 3rd month from diagnosis and clinical data regarding i.e. medical treatment, surgery and investigations entered in a web-based database, www.epicom-ecco.eu. Costs were calculated in Euro (€) using the Danish Health Costs Register.

Results

1,367 patients were followed-up, 710 with ulcerative colitis (UC), 509 with Crohn's disease (CD) and 148 with IBD unclassified (IBDU). Total expenditure for the cohort was € 5,408,174 [Investigations: € 2,042,990 (38%), surgery: € 1,427,648 (26%), biologicals: € 781,089 (14%), standard treatment (all other than biologicals): € 1,156,520 (22%)]. Expenditures for CD, UC and IBDU in Eastern and Western Europe are shown in Table 1 and the distribution of cumulative expenses for CD and UC in both regions combined are shown in Figures 1 and 2. Mean crude expenditure per patient in Western Europe (Eastern Europe) with CD where: investigations € 1,803 (€ 2,160) (p = 0.44), surgery € 11,489 (€ 13,973) (p = 0.14), standard treatment € 1,027 (€ 824) (p = 0.51), biologicals € 7,376 (€ 8,307) (p = 0.31). Mean crude expenditure per patient in Western Europe (Eastern Europe) with UC where: investigations € 1,189 (€ 1,518) (p < 0.01), surgery € 18,414 (€ 12,395) (p = 0.18), standard treatment € 896 (€ 798) (p < 0.05), biologicals € 5,681 (€ 72) (p = 0.51). Overall cost per IBD patient or the whole cohort was approx. € 4,000 with € 1,500 spent on investigations, € 1,000 on surgery and standard medication respectively, and € 500 on biological therapy.

Table 1 (abstract OP008). Total cost (Euros) for resources used in the first year of follow-up of 1,367 patients with inflammatory bowel disease
CDUCIBDU
RegionWestEastWestEastWestEast
Examinations724,922 (29%)220,342 (44%)661,163 (42%)224,656 (62%)204,526 (49%)7,381 (68%)
Standard medication384,134 (15%)84,896 (17%)462,560 (28%)115,160 (32%)106,270 (25%)3,500 (32%)
Biological therapy553,198 (22%)41,533 (8%)153,399 (10%)72 (0%)32,815 (8%)0 (0%)
Surgery861,686 (34%)153,699 (31%)313,040 (20%)24,791 (6%)74,432 (18%)0 (0%)
Total2,523,939 (100%)500,470 (100%)1,590,162 (100%)364,680 (100%)418,043 (100%)10,881 (100%)

Conclusion

In this population-based unselected cohort including indolent and severe cases costs during the first year of disease were mainly incurred by the large number of investigative procedures and surgeries with however biological therapy accounting for already more than 15% of costs. Long-term follow-up of the cohort is needed to assess the cost effectiveness of biological agents.

1. Burisch J et al., (2013), East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort, Gut.