P579. A cost of care model for inflammatory bowel disease
N. Ghosh1, S. Leonard2, G. Miles2, P. Premchand1, 1Barking, Havering and Redbridge University Hospitals NHS Trust, Queen's Hospital, Romford, United Kingdom, 2Costello Medical Consulting, Publications, Cambridge, United Kingdom
There are an estimated 620,000 patients with inflammatory bowel disease (IBD) in the UK. The rising incidence of IBD combined with its incurability has significant cost implications, with the National IBD Audit estimating that cost to the National Health Service (NHS) exceeded £1 billion in 2010. The aim of this cost of care model was to calculate the annual cost per patient of treating ulcerative colitis (UC) and Crohn's disease (CD) from an NHS perspective, and to enable areas of potential cost savings to be explored.
The cost of IBD was calculated by summing the costs of treatment, treatment side effects and disease-related complications, accounting for the proportions of patients incurring these costs. The model included detailed costs for each treatment (eg. brand of mesalazine), major side effects for each treatment (eg. pancreatitis from thiopurines) and complications (eg. pyoderma gangrenosum). Default input values for costs, the percentage of patients receiving each treatment, and the percentage of patients experiencing side effects or complications were determined from national sources and published literature. However, the model permitted the user to input local or alternative data (eg. to reflect brand preferences for oral mesalazines).
Using default input values, the annual cost of treating any UC patient was estimated to be £3,084. For a UC patient in remission, in relapse with mild-to-moderate UC or in relapse with severe UC, annual cost per patient was estimated to be £1,693, £2,903 and £10,760, respectively. The annual cost for any CD patient was estimated to be £6,156 (£1,800 for patients in remission; £10,513 for patients in relapse).
When the percentage of relapsing CD patients on adalimumab was increased from 5% to 10%, the annual cost per relapsing CD patient rose from £10,513 to £11,032. The overall annual cost for any CD patient rose from £6,156 to £6,416.
If we consider non-medical therapy, increasing the percentage of mild-to-moderate UC patients on leukapheresis from 0.5% to 8% increased the annual cost per mild-to-moderate patient from £2,903 to £3,352, and the annual cost for any UC patient from £3,083 to £3,263. However, assuming that increased use of leukapheresis would cause a decrease from 20% to 15% in the annual proportion of patients experiencing acute severe flares, the annual cost for any UC patient fell to £3,078.
While IBD remains a costly condition with modest potential cost savings, this model facilitates calculation of annual costs per UC and CD patient, and its customisability will help hospitals to identify areas where savings could be made.