Hospitalization in Crohn’s Disease
While the management of Crohn’s disease (CD) has shifted to the outpatient setting in the past 20 years, hospitalization for CD remains an important component of management and usually results in high resource utilization and cost. Hospitalization results in disruption of the everyday lives of patients, many of whom are in their prime years for productivity. There are several ways to assess the impact of hospitalization on the cost of CD, as well as many variables introduced by the diversity of health care systems. Many studies have utilized a "prevalence" approach in which cross-sectional data are analyzed. Despite some variability, some consistent trends emerge across trials.
Despite advances in therapies, hospitalization continues to be responsible for the largest portion of the health care costs related to the management of CD. Cost-of-illness studies focusing on direct medical costs have identified that over half the average cost associated with the disease is related to hospital costs.2039
Figure 521 – Table I. Cost of Illness Studies That Provide Estimates for Drug Costs and Hospitalization Costs
Table I, Cost of illness of Crohn’s disease. Pharmacoeconomics. 2002;20(10):639-652 is used with permission from Wolters Kluwer Health.
Some figures may not display clearly when rendered as a PDF or printed.
Blomqvist and Ekbom obtained 1994 data from a variety of national registries and surveys: they found that the annual hospitalization rate for CD was 39 per 100,000 population per year with a per-person average of 1.5 admissions. Only a minority of patients (about 1 in 9; 11%) required admission to the hospital. It is clear that the distribution of cost for CD is skewed by the fact that a relatively small group of seriously affected individuals required hospital intervention, some requiring repeated hospitalization.2064
Data from a large US medical insurance database covering a 12-month period (1988-1989) were analyzed. The average number of claims per patient was approximately 1.5. The most seriously ill patients (approximately 2%) accounted for 28.9% of the total charges.2101
A separate US prescription drug and medical claims
database was analyzed for CD-related claims between
Bernstein, et al., and Cohen, et al., reviewed data from tertiary care hospitals in Canada and the United States, respectively, to determine the hospital-associated costs of CD. Both found that the mean length of stay for patients requiring surgical intervention was longer (9.6 days) than for those requiring medical management (8 days).2074, 2762
Hospitalization accounts for the majority of the costs associated with CD. Two different claims databases reviewed in the United States revealed that 55.8%2101 and 57%2085 of total direct costs to the patients were attributable to hospitalization. In a cross-sectional review of Swedish national registries and surveys, investigators found a similar rate of 58% of the direct costs of CD due to inpatient hospital care.2064
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References:| 2039. | Bodger K. Cost of illness of Crohn’s disease. Pharmacoeconomics . 2002;20(10):639-652. |
| 2064. | Blomqvist P, Ekbom A. Inflammatory bowel diseases: health care and costs in Sweden in 1994. Scand J Gastroenterol. 1997;32(11):1134-1139. |
| 2074. | Cohen RD, Larson LR, Roth JM, Becker RV, Mummert LL. The cost of hospitalization in Crohn’s disease. Am J Gastroenterol. 2000;95(2):524-530. |
| 2085. | Feagan BG, Vreeland MG, Larson LR, Bala MV. Annual cost of care for Crohn’s disease: a payor perspective. Am J Gastroenterol. 2000;95(8):1955-1960. |
| 2101. | Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992;14(4):309-317. |
| 2762. | Bernstein CN, Papineau N, Zajaczkowski J, Rawsthorne P, Okrusko G, Blanchard JF. Direct hospital costs for patients with inflammatory bowel disease in a Canadian tertiary care university hospital. Am J Gastroenterol . 2000;95(3):677-683. |
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