Impact on Patients
Patients with Crohn’s disease and ulcerative colitis can, and do, lead full and productive lives. However, when these diseases are active, they can have significant impact on the quality of life for patients due to flare-ups and complications. Complications, which are described in the “Signs and Symptoms” section, can occur inside or outside the GI tract.
In Crohn’s disease, a recent review of studies29 showed that complications inside the GI tract (such as strictures) occurred in:
- up to 33% of patients at the time of diagnosis
- approximately 50% of patients within 20 years of diagnosis
In ulcerative colitis:
- 50% of patients have mild disease at the time of diagnosis
- up to 19% of patients have severe disease at the time of diagnosis
- 90% of patients have at least one relapse of active symptoms within 25 years of diagnosis
Use of the Healthcare System
People with IBD most often receive care in physicians’ offices or other outpatient sites. Hospitalization is required for severe disease, to treat certain complications, and for surgery.
Crohn’s Disease
- In 2004, there were 1.1 million ambulatory care visits (the number of specific disease-related visits made annually to office-based health care providers, hospital outpatient clinics, and emergency departments) for Crohn’s disease.30
- In 2004, there were 1.8 million prescriptions written for medications to treat Crohn’s disease.30
- In 2010, there were 187,000 hospitalizations specifically for Crohn’s disease.31
Ulcerative Colitis
- In 2004, there were 716,000 ambulatory care visits for ulcerative colitis.30
- In 2004, there were 2.1 million prescriptions written for medications to treat ulcerative colitis.30
- In 2010, there were 107,000 hospitalizations specifically for ulcerative colitis.31
Psychological Health
Having a chronic illness such as IBD can be emotionally burdensome. Symptoms of IBD can flare up unexpectedly and can be painful, uncomfortable, inconvenient, and embarrassing. IBD patients may experience a wide range of emotions in response to having these conditions.
Some IBD patients react to the unpredictable and sometimes severe nature of IBD symptoms with feelings of anger, anxiety, or fear. They may also have elevated stress levels. In addition, stressful situations (even those unrelated to the disease itself) may lead to flare-ups of symptoms.
Depression is a serious disorder that can affect some people with IBD. However, depression is treatable with psychological counseling and/or antidepressant drugs. Mental health counseling and support groups can be extremely helpful in dealing with the psychological impact of IBD.
Financial Burden
There are both direct and indirect costs associated with IBD. Direct medical costs include expenses for hospitalizations, physician services, prescription drugs, over-the-counter drugs, skilled nursing care, diagnostic procedures, and other healthcare services. Indirect costs are the value of lost earnings or productivity. Indirect costs also include the value of leisure time lost.
Direct Costs
- Studies have estimated the annual direct cost of Crohn’s disease to be from $8,265 per patient (based on 2003-2004 US insurance claims data)32 to $18,963 per patient (based on 1999-2005 MarketScan database data).33
- Studies have estimated the annual direct cost of ulcerative colitis to be from $5,066 per patient (based on 2003-2004 US insurance claims data)32 to $15,020 per patient (based on 1999-2005 MarketScan database data).33
- Extrapolating from the study data listed above to the current prevalence estimates of IBD (780,000 cases of Crohn’s disease and 907,000 cases of ulcerative colitis), the total annual direct costs for all patients with IBD (both Crohn’s disease and ulcerative colitis) in the United States is estimated to be between $11 billion to $28 billion.
Indirect Costs
- Based on a national health survey in 1999, nearly 32% of symptomatic IBD patients reported being out of the workforce in a one-year period, incurring an indirect cost of an estimated $5,228 per patient, bringing the total indirect cost of IBD in 1999 to $3.6 billion.34
Using the data listed above, the total annual financial burden (adding direct and indirect costs) of IBD in the US is an estimated $14.6 billion to $31.6 billion.
References:
29. Peyrin-Biroulet L, Loftus EV Jr, Colombel J-F, Sandborn WJ. The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol. 2010;105:289-297.
30. Ruhl CE, Sayer B, Byrd-Holt DD, Brown DM. In: Everhart JE, editor. The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, 2008; NIH Publication No. 09-6443. pp. 137-147.
31. CDC/NCHS national hospital discharge survey: United States, 2010. Centers for Disease Control and Prevention website. www.cdc.gov/nchs/data/nhds/10Detaileddiagnosesprocedures/ 2010det10_numberalldiagnoses.pdf. (PDF, 1,506 KB)* Accessed May 2, 2013.
32. Kappelman MD, Rifas-Shiman SL, Porter CQ, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135(6):1907-1913.
33. Gibson TB, Ng E, Ozminkowski RJ, et al. The direct and indirect cost burden of Crohn’s disease and ulcerative colitis. Occup Environ Med. 2008;50:1261-1272.
34. Longobardi T, Jacobs P, Bernstein CN. Work losses related to inflammatory bowel disease in the United States: Results from the National Health Interview Survey. The American Journal of Gastroenterology. 2003:98,1064-1072