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Assessment of Health Care cost in a chronic disease on an International level using standardized units for description of single care commodities

Background & Aims: Economic analysis in chronic diseases is a prerequisite for planning a proper distribution of health care resources. We aimed to determine the cost of inflammatory bowel disease, a lifetime illness with considerable morbidity. Methods: We studied 1321 patients from an inception cohort in eight European countries and Israel over ten years. Data on consumption of resources were obtained retrospectively.

Cost of health care was calculated from use of resources and their median prices. Data were analyzed using regression models based on the generalized estimating equations approach.

Results: The mean annual total expenditure on health care was 1871 /patient-year for inflammatory bowel disease, 1524 /patient-year for ulcerative colitis, and 2548 /patient-year for Crohn's disease (P < .001). The most expensive resources were medical and surgical hospitalizations, together accounting for 63% of the cost in Crohn¿s disease and 45% in ulcerative colitis. Total and hospitalization costs were much higher in the first year after diagnosis than subsequently. Differences of medical and surgical hospitalizations were the primary cause of substantial inter-country variations of cost; the mean cost of health care was 3705 /patient-year in Denmark and 888 /patient-year in Norway. The outlay on 5-aminosalicylate, a costly medication with extensive use, was greater than on all other drugs combined. Age at diagnosis and sex did not affect costs. Conclusions: In this multinational, population-based, time-dependent characterization of the health care cost of inflammatory bowel disease, increased expenditure was driven largely by country, diagnosis, hospitalization and follow-up year.

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Dept of Gastroenterology, Ben Gurion University
P.O.Box 151
84101 Beer Sheva
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