Health care costs and their predictors of inflammatory bowel diseases in Germany
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Detailed cost studies of inflammatory bowel diseases (IBD) for Germany are limited. Aim of this study was to collect resource-use data related to IBD via a cross-sectional study, to quantify these from the perspective of the Statutory Health Insurance (SHI) and to identify cost-driving factors.
Patients with Crohn’s disease (CD) or ulcerative colitis (UC) from 24 gastroenterological specialists’ practices and two hospitals were enrolled in an internet-based database between March 2006 and July 2007. Outpatient services, inpatient visits as well as medication usage were recorded and evaluated from the perspective of the SHI for 2007. Disease severity was measured by the Crohn’s Disease Activity Index (CDAI) and the Colitis Activity Index (CAI), respectively. Extensive statistical analyses including generalized linear modeling (gamma model with the log link) to identify cost-driving factors were performed.
Data from 1,030 patients with IBD (CD: 511; UC: 519) were collected. On average a patient with CD incurs annual costs of EUR 3,767 (±5,895 (SD)) (among those 68.5% medication; 20.5% inpatient) and an average patient with UC incurs EUR 2,478 (±4,591) (74% medication; 10% inpatient), whereas 10% of the patient with IBD account for 49% (CD: 50%; UC: 46%) of the costs. The regression analysis showed that especially the use of TNF-alpha-inhibitors, inpatient stays, gender as well as the severity status has a significant influence on costs. Further disease-specific impact factors were identified.
This is the first study to calculate costs due to CD and UC from the perspective of the SHI in Germany and to identify cost-driving factors. It confirms a high economic burden of IBD to payers and society.
KeywordsCost analyses Inflammatory bowel diseases Germany Generalized linear models Cost of illness
JEL ClassificationI10 I11 I12
Conflict of interest
No funding was received for the cost analysis or writing of this manuscript.
- 1.Crohn, B.B., Ginzburg, L., Oppenheimer, G.D.: Regional ileitis—a pathologic and clinical entity. JAMA 99, 1323–1329 (1932)Google Scholar
- 7.Federal Statistical Office: Costs of illness accounts. Wiesbaden (2008)Google Scholar
- 17.National Association of Statutory Health Insurance Physicians: Appendix 3 regarding the resolution of the assessment committee according to § 87 para. 1 SGB V for determining the standard service volumes by the Associations of Statutory Health Insurance Physicians according to § 85 para. 4a SGB V. (2008)Google Scholar
- 19.Federal Statistical Office: Diagnosis data of patients in hospitals 2006, Fachserie 12 Reihe 6.2.1. Wiesbaden (2008)Google Scholar
- 20.InEK GmbH—Institute for the Hospital Remuneration System: G-DRG Definition Handbook, Version 2007. Siegburg (2006)Google Scholar
- 21.Federal Association of Local Health Care Funds: Overview of the case values in the single federal states (2007)Google Scholar
- 22.InEK GmbH—Institute for the Hospital Remuneration System: Diagnosis Related Group-Catalogue 2007 (2006)Google Scholar
- 23.LAUER-FISCHER GmbH. Lauer-Taxe online (www.lauer-fischer.de)
- 36.Holtmann, M.H., Krummenauer, F., Claas, C. et al.: Significant differences between Crohn’s disease and ulcerative colitis regarding the impact of body mass index and initial disease activity on responsiveness to azathioprine: results from a european multicenter study in 1,176 patients. Dig. Dis. Sci. 55, 1066–1078 (2010)Google Scholar
- 39.Häussler, B., Höer, A., Hempel, E. et al.: Arzneimittel-Atlas 2009: Der Arzneimittelverbrauch in der GKV. Munich. (2009)Google Scholar