Original Article

Digestive Diseases and Sciences

, Volume 57, Issue 12, pp 3080-3091

First online:

Direct Health Care Insurer and Out-of-Pocket Expenditures of Inflammatory Bowel Disease: Evidence from a US National Survey

  • Candace GunnarssonAffiliated withS2 Statistical Solutions, Inc.
  • , Jie ChenAffiliated withDepartment of Political Science, Economics, and Philosophy, College of Staten Island, CUNYDepartment of Health Services Administration, School of Public Health, University of Maryland
  • , John A. RizzoAffiliated withDepartment of Preventive Medicine, Stony Brook UniversityDepartment of Economics, Stony Brook University
  • , Joseph A. LadapoAffiliated withHarvard Medical SchoolDepartment of Medicine, Beth Israel Deaconess Medical CenterDepartment of Population Medicine, New York University
  • , Jennifer H. LoflandAffiliated withJanssen Scientific Affairs, LLC Email author 

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Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, debilitating conditions that can have important economic and clinical implications.


To quantify individual and national estimates of the health care and patient out-of-pocket (OOP) costs of CD and UC.


In a retrospective study using 1996 to 2009 data from the Medical Expenditure Panel Survey, individuals’ self-reported health conditions were mapped to International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Individuals with a code of 555.x (CD) or 556.x (UC) were identified. Health care services and costs included prescriptions and inpatient, outpatient, emergency room, office, and home health services. OOP costs were the portion of individuals’ total payments for health care services.


There were 358 individuals with CD (mean age 49.0 years; 55 % female), 198 individuals with UC (mean age 47.1 years; 64 % female), and 206,993 individuals without inflammatory bowel disease (IBD) (mean age 48.2 years; 58 % female). Annual per capita health insurer and OOP costs for individuals with CD were greater than those without IBD ($9,526 versus $3,781, p < 0.001 and $1,603 versus $866, p < 0.001, respectively). Health insurer and OOP costs were greater for UC compared with those without IBD ($6,443 versus $3,781, p < 0.001 and $1,263 versus $866, p < 0.001, respectively). US national aggregate annual estimates of health insurer, OOP, and total direct costs secondary to CD are $2.04 billion, $0.26 billion, and $2.29 billion, respectively. Aggregate health insurer, OOP, and total direct costs attributable to UC are $0.53 billion, $0.07 billion, and $0.61 billion, respectively.


The direct costs associated with CD and UC are substantial. The extent to which appropriate diagnosis and treatment reduces the total health care costs for individuals with CD or UC should be examined.


Costs and cost analysis Crohn’s disease Health care costs Health expenditures Inflammatory bowel disease Ulcerative colitis