Digestive Diseases and Sciences

, Volume 60, Issue 2, pp 299–312 | Cite as

The Economic and Quality-of-Life Burden of Crohn’s Disease in Europe and the United States, 2000 to 2013: A Systematic Review

  • David N. Floyd
  • Sue Langham
  • Hélène Chevrou Séverac
  • Barrett G. LevesqueEmail author



Crohn’s disease (CD) is associated with a substantial healthcare burden that affects the patient, healthcare systems and society in general.


To provide a systematic evaluation of published data relating to the economic and health-related quality-of-life (HRQoL) burden of CD in selected European countries (Germany, France, UK, Italy, Spain) and the USA since 2000.


We undertook a systematic review of publications relating to CD, its economic burden and impact on HRQoL. Research questions focused on the disease costs from a societal perspective and HRQoL burden in adults and pediatric/adolescent patients according to disease stage/severity. Total, direct and indirect costs were identified, as well as the impact of CD on HRQoL measured using both generic and disease-specific instruments.


Overall, 61 publications met the research criteria (38 on costs, 23 on HRQoL). CD in the USA and Europe together was associated with annual total costs of nearly €30 billion, more than half due to indirect costs. HRQoL was consistently and statistically significantly lower among CD patients compared with normal populations, due to physical, emotional and social effects.


CD is a global health problem with high societal costs and substantial HRQoL burden. High-value care pathways including cost-effective therapies will help to induce and maintain remission, reduce complications of disease and improve HRQoL.


Crohn’s disease Epidemiology Prevalence Incidence Cost burden Quality of life Quality-of-life burden 


Conflict of interest

DF: employed by PHMR: PHMR received an unrestricted grant from Nestlé Health Science S.A. to perform the systematic literature search. SL: employed by PHMR: PHMR received an unrestricted grant from Nestlé Health Science S.A. to perform the systematic literature search. HS: previous employee of Nestle Health Sciences. BGL: Received consulting fees from Prometheus Labs, Santarus Inc., and Nestle Health Sciences, Abbvie and Takeda.

Supplementary material

10620_2014_3368_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)


  1. 1.
    Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–1794.PubMedCrossRefGoogle Scholar
  2. 2.
    Isaacs KL. How rapidly should remission be achieved? Dig Dis. 2010;28:548–555.PubMedCrossRefGoogle Scholar
  3. 3.
    De Buck van Overstraeten A, Wolthuis A, D’Hoore A. Surgery for Crohn’s disease in the era of biologicals: a reduced need or delayed verdict? World J Gastroenterol. 2012;18:3828–3832.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Cheifetz AS. Management of active Crohn disease. JAMA. 2013;309:2150–2158.PubMedCrossRefGoogle Scholar
  5. 5.
    Ezri J, Marques-Vidal P, Nydegger A. Impact of disease and treatments on growth and puberty of pediatric patients with inflammatory bowel disease. Digestion. 2012;85:308–319.PubMedCrossRefGoogle Scholar
  6. 6.
    Magro F, Portela F. Management of inflammatory bowel disease with infliximab and other anti-tumor necrosis factor alpha therapies. BioDrugs. 2010;24:3–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Lev-Tzion R, Turner D. Is pediatric IBD treatment different than in adults? Minerva Gastroenterol Dietol. 2012;58:137–150.PubMedGoogle Scholar
  8. 8.
    National Institute for Health and Clinical Excellence (NICE). Crohn’s Disease. Management in Adults and Children. London: NICE; 2012.Google Scholar
  9. 9.
    Sandhu BK, Fell JM, Beattie RM, et al. Guidelines for the management of inflammatory bowel disease in children in the United Kingdom. J Pediatr Gastroenterol Nutr. 2010;50:S1–S13.PubMedCrossRefGoogle Scholar
  10. 10.
    Hommes D, Colombel JF, Emery P, Greco M, Sandborn WJ. Changing Crohn’s disease management: need for new goals and indices to prevent disability and improve quality of life. J Crohns Colitis. 2012;6:S224–S234.PubMedCrossRefGoogle Scholar
  11. 11.
    Wilson B, Lonnfors S, Hommes DW, et al. A European Crohn’s and ulcerative colitis patient life IMPACT survey. J Crohn’s Colitis. 2012;6:S171.CrossRefGoogle Scholar
  12. 12.
    Cohen RD, Yu AP, Wu EQ, Xie J, Mulani PM, Chao J. Systematic review: the costs of ulcerative colitis in Western countries. Aliment Pharmacol Ther. 2010;31:693–707.PubMedCrossRefGoogle Scholar
  13. 13.
    Dyson JK, Rutter MD. Colorectal cancer in inflammatory bowel disease: what is the real magnitude of the risk? World J Gastroenterol. 2012;18:3839–3848.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Yu AP, Cabanilla LA, Wu EQ, Mulani PM, Chao J. The costs of Crohn’s disease in the United States and other Western countries: a systematic review. Curr Med Res Opin. 2008;24:319–328.PubMedCrossRefGoogle Scholar
  15. 15.
    Gibson TB, Ng E, Ozminkowski RJ, et al. The direct and indirect cost burden of Crohn’s disease and ulcerative colitis. J Occup Environ Med. 2008;50:1261–1272.PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen RD, Waters HC, Tang B, Rahman MI. Effects of fistula on healthcare costs and utilization for patients with Crohn’s disease treated in a managed care environment. Inflamm Bowel Dis. 2008;14:1707–1714.PubMedCrossRefGoogle Scholar
  17. 17.
    Stark R, Konig HH, Leidl R. Costs of inflammatory bowel disease in Germany. Pharmacoeconomics. 2006;24:797–814.PubMedCrossRefGoogle Scholar
  18. 18.
    Benedini V, Caporaso N, Corazza GR, et al. Burden of Crohn’s disease: economics and quality of life aspects in Italy. Clin Outcomes Res. 2012;4:209–218.Google Scholar
  19. 19.
    Juan J, Estiarte R, Colome E, Artes M, Jimenez FJ, Alonso J. Burden of illness of Crohn’s disease in Spain. Dig Liver Dis. 2003;35:853–861.PubMedCrossRefGoogle Scholar
  20. 20.
    Lichtenstein GR, Cuffari C, Kane SV, Hanauer S, Present DH. Maintaining remissions across the lifespan: a roundtable with Crohn’s disease experts. Inflamm Bowel Dis. 2004;10:S11–S21.PubMedCrossRefGoogle Scholar
  21. 21.
    Gomollon Garcia F, Gonzalez Lama Y, et al. Work productivity and activity impairment in Spanish Crohn’s disease patients. J Crohns Colitis. 2012;6:S115.CrossRefGoogle Scholar
  22. 22.
    Dorrian A, Dempster M, Adair P. Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping. Inflamm Bowel Dis. 2009;15:47–55.PubMedCrossRefGoogle Scholar
  23. 23.
    Albert JG, Kotsch J, Kostler W, et al. Course of Crohn’s disease prior to establishment of the diagnosis. Z Gastroenterol. 2008;46:187–192.PubMedCrossRefGoogle Scholar
  24. 24.
    Button LA, Roberts SE, Goldacre MJ, Akbari A, Rodgers SE, Williams JG. Hospitalized prevalence and 5-year mortality for IBD: record linkage study. World J Gastroenterol. 2010;16:431–438.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Bassi A, Dodd S, Williamson P, Bodger K. Cost of illness of inflammatory bowel disease in the UK: a single centre retrospective study. Gut. 2004;53:1471–1478.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Prenzler A, Bokemeyer B, Von Der Schulenburg JM, Mittendorf T. Health care costs and their predictors of inflammatory bowel diseases in Germany. Eur J Heal Econ. 2011;12:273–283.CrossRefGoogle Scholar
  27. 27.
    Ebinger M, Leidl R, Thomas S, et al. Cost of outpatient care in patients with inflammatory bowel disease in a German University Hospital. J Gastroenterol Hepatol. 2004;19:192–199.PubMedCrossRefGoogle Scholar
  28. 28.
    Heaton PC, Tundia NL, Schmidt N, Wigle PR, Kelton CM. National burden of pediatric hospitalizations for inflammatory bowel disease: results from the 2006 Kids’ Inpatient Database. J Pediatr Gastroenterol Nutr. 2012;54:477–485.PubMedCrossRefGoogle Scholar
  29. 29.
    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;135:1907–1913.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Odes S, Vardi H, Friger M, et al. Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation. Gastroenterology. 2006;131:719–728.PubMedCrossRefGoogle Scholar
  31. 31.
    Buchanan J, Wordsworth S, Ahmad T, et al. Managing the long term care of inflammatory bowel disease patients: the cost to European health care providers. J Crohns Colitis. 2011;5:301–316.PubMedCrossRefGoogle Scholar
  32. 32.
    Gunnarsson C, Chen J, Rizzo JA, Ladapo JA, Lofland JH. Direct health care insurer and out-of-pocket expenditures of inflammatory bowel disease: evidence from a US national survey. Dig Dis Sci. 2012;57:3080–3091.PubMedCrossRefGoogle Scholar
  33. 33.
    Reinshagen M, Bokemeyer B, Krummenerl T, et al. Quality of life of Crohn’s disease patients under immunosuppressive therapy in Germany preliminary results of the DaLi study. J Crohns Colitis. 2013;7:S169.CrossRefGoogle Scholar
  34. 34.
    Casellas F, Arenas JI, Baudet JS, et al. Impairment of health-related quality of life in patients with inflammatory bowel disease: a Spanish multicenter study. Inflamm Bowel Dis. 2005;11:488–496.PubMedCrossRefGoogle Scholar
  35. 35.
    Huaman JW, Casellas F, Borruel N, et al. Cutoff values of the Inflammatory Bowel Disease Questionnaire to predict a normal health related quality of life. J Crohns Colitis. 2010;4:637–641.PubMedCrossRefGoogle Scholar
  36. 36.
    Lichtenstein GR, Yan S, Bala M, Hanauer S. Remission in patients with Crohn’s disease is associated with improvement in employment and quality of life and a decrease in hospitalizations and surgeries. Am J Gastroenterol. 2004;99:91–96.PubMedCrossRefGoogle Scholar
  37. 37.
    Feagan BG, Sandborn WJ, Hass S, Niecko T, White J. Health-related quality of life during natalizumab maintenance therapy for Crohn’s disease. Am J Gastroenterol. 2007;102:2737–2746.PubMedCrossRefGoogle Scholar
  38. 38.
    Thaler K, Dinnewitzer A, Oberwalder M, Weiss EG, Nogueras JJ, Wexner SD. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn’s disease. Color Dis. 2005;7:375–381.CrossRefGoogle Scholar
  39. 39.
    Bastida G, Nos P, Aguas M, et al. The effects of thiopurine therapy on health-related quality of life in Inflammatory Bowel Disease patients. BMC Gastroenterol. 2010;10:26.Google Scholar
  40. 40.
    Casellas F, Lopez-Vivancos J, Badia X, Vilaseca J, Malagelada JR. Influence of inflammatory bowel disease on different dimensions of quality of life. Eur J Gastroenterol Hepatol. 2001;13:567–572.PubMedCrossRefGoogle Scholar
  41. 41.
    Casellas F, Lopez-Vivancos J, Casado A, Malagelada JR. Factors affecting health related quality of life of patients with inflammatory bowel disease. Qual Life Res. 2002;11:775–781.PubMedCrossRefGoogle Scholar
  42. 42.
    Valentini L, Schaper L, Buning C, et al. Malnutrition and impaired muscle strength in patients with Crohn’s disease and ulcerative colitis in remission. Nutrition. 2008;24:694–702.PubMedCrossRefGoogle Scholar
  43. 43.
    Perrin JM, Kuhlthau K, Chughtai A, et al. Measuring quality of life in pediatric patients with inflammatory bowel disease: psychometric and clinical characteristics. J Pediatr Gastroenterol Nutr. 2008;46:164–171.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Casellas F, Rodrigo L, Nino P, Pantiga C, Riestra S, Malagelada JR. Sustained improvement of health-related quality of life in Crohn’s disease patients treated with infliximab and azathioprine for 4 years. Inflamm Bowel Dis. 2007;13:1395–1400.PubMedCrossRefGoogle Scholar
  45. 45.
    Barratt SM, Leeds JS, Robinson K, et al. Reflux and irritable bowel syndrome are negative predictors of quality of life in coeliac disease and inflammatory bowel disease. Eur J Gastroenterol Hepatol. 2011;23:159–165.PubMedCrossRefGoogle Scholar
  46. 46.
    Piche T, Ducrotte P, Sabate JM, et al. Impact of functional bowel symptoms on quality of life and fatigue in quiescent Crohn disease and irritable bowel syndrome. Neurogastroenterol Motil. 2010;22:626+e174–632+e174.Google Scholar
  47. 47.
    Petrak F, Hardt J, Clement T, Borner N, Egle UT, Hoffmann SO. Impaired health-related quality of life in inflammatory bowel diseases: psychosocial impact and coping styles in a national German sample. Scand J Gastroenterol. 2001;36:375–382.PubMedCrossRefGoogle Scholar
  48. 48.
    Graff LA, Vincent N, Walker JR, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1882–1889.PubMedCrossRefGoogle Scholar
  49. 49.
    Liu Y, Wu EQ, Bensimon AG, et al. Cost per responder associated with biologic therapies for Crohn’s disease, psoriasis, and rheumatoid arthritis. Adv Ther. 2012;29:620–634.PubMedCrossRefGoogle Scholar
  50. 50.
    Sussman DA, Kubiliun N, Mulani PM, et al. Comparison of medical costs among patients using adalimumab and infliximab: a retrospective study (COMPAIRS). Inflamm Bowel Dis. 2012;18:2043–2055.PubMedCrossRefGoogle Scholar
  51. 51.
    Waters HC, Vanderpoel JE, Nejadnik B, et al. Resource utilization before and during infliximab therapy in patients with inflammatory bowel disease. J Med Econ. 2012;15:45–52.PubMedCrossRefGoogle Scholar
  52. 52.
    Khanna R, Levesque BG, Bressler B, et al. Early Combined Immunosuppression for the Management of Crohn’s Disease: A Community-Based Cluster Randomized Trial. Copenhagen: ECCO; 2014 [Abstract OP004].Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • David N. Floyd
    • 1
  • Sue Langham
    • 1
  • Hélène Chevrou Séverac
    • 2
  • Barrett G. Levesque
    • 3
    • 4
    Email author
  1. 1.PHMR AssociatesLondonUK
  2. 2.Nestlé Health Science S.A.VeveySwitzerland
  3. 3.Academic Research, Robarts Clinical TrialsUniversity of Western OntarioLondonCanada
  4. 4.Division of GastroenterologyUniversity of California, San DiegoLa JollaUSA

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