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The European Journal of Health Economics

, Volume 12, Issue 3, pp 273–283 | Cite as

Health care costs and their predictors of inflammatory bowel diseases in Germany

  • Anne PrenzlerEmail author
  • Bernd Bokemeyer
  • J.-Matthias von der Schulenburg
  • Thomas Mittendorf
Original Paper

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Cost analyses Inflammatory bowel diseases Germany Generalized linear models Cost of illness 

JEL Classification

I10 I11 I12 

Notes

Conflict of interest

No funding was received for the cost analysis or writing of this manuscript.

References

  1. 1.
    Crohn, B.B., Ginzburg, L., Oppenheimer, G.D.: Regional ileitis—a pathologic and clinical entity. JAMA 99, 1323–1329 (1932)Google Scholar
  2. 2.
    Baumgart, D.C., Sandborn, W.J.: Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 369, 1641–1657 (2007)PubMedCrossRefGoogle Scholar
  3. 3.
    Bokemeyer, B.: IBD-treatment in Germany. Gastroenterologe 2, 447–455 (2007)CrossRefGoogle Scholar
  4. 4.
    Brandes, J.W., Lorenz-Meyer, H.: Epidemiologic aspects of Crohn regional enterocolitis and ulcerative colitis in Marburg/Lahn (West Germany) between 1962 and 1975. Z. Gastroenterol. 21, 69–78 (1983)PubMedGoogle Scholar
  5. 5.
    Daiss, W., Scheurlen, M., Malchow, H.: Epidemiology of inflammatory bowel disease in the county of Tubingen (West Germany). Scand. J. Gastroenterol. Suppl. 170, 39–43 (1989)PubMedCrossRefGoogle Scholar
  6. 6.
    Goebell, H., Dirks, E., Förster, S., et al.: A prospective analysis of the incidence and prevalence of Crohn’s disease in an urban population in Germany. Eur. J. Gastroenterol. Hepatol. 6, 1039–1045 (1994)CrossRefGoogle Scholar
  7. 7.
    Federal Statistical Office: Costs of illness accounts. Wiesbaden (2008)Google Scholar
  8. 8.
    Beiche, A., Konig, H.H., Ebinger, M., et al.: Costs of ambulant care for patients with inflammatory bowel disease in general practice. Z. Gastroenterol. 41, 527–536 (2003)PubMedCrossRefGoogle Scholar
  9. 9.
    Blumenstein, I., Bock, H., Weber, C., et al.: Health care and cost of medication for inflammatory bowel disease in the Rhein-Main region, Germany: a multicenter, prospective, internet-based study. Inflamm. Bowel Dis. 14, 53–60 (2008)PubMedCrossRefGoogle Scholar
  10. 10.
    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. 19, 192–199 (2004)PubMedCrossRefGoogle Scholar
  11. 11.
    Rösch, M., Leidl, R., Thomas, S., et al.: Measurement of outpatient treatment costs of chronic inflammatory bowel diseases at a German university hospital. Med Klin (Munich) 97, 128–136 (2002)CrossRefGoogle Scholar
  12. 12.
    Stark, R., Konig, H.H., Leidl, R.: Costs of inflammatory bowel disease in Germany. Pharmacoeconomics 24, 797–814 (2006)PubMedCrossRefGoogle Scholar
  13. 13.
    Rösch, M., Leidl, R., von Tirpitz, C., et al.: Cost measurement based on a cost diary in patients with inflammatory bowel disease. Z. Gastroenterol. 40, 217–228 (2002)PubMedCrossRefGoogle Scholar
  14. 14.
    Best, W.R., Becktel, J.M., Singleton, J.W., et al.: Development of a Crohn’s disease activity index. National cooperative Crohn’s disease study. Gastroenterology 70, 439–444 (1976)PubMedGoogle Scholar
  15. 15.
    Rachmilewitz, D.: Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. BMJ 298, 82–86 (1989)PubMedCrossRefGoogle Scholar
  16. 16.
    Braun, S., Prenzler, A., Mittendorf, T., et al.: Appraisal for the valuation of resource use in the German health-care system from the perspective of the statutory health insurance. Gesundheitswesen 71, 19–23 (2009)PubMedCrossRefGoogle Scholar
  17. 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
  18. 18.
    Hoffmann, J.C., Preiss, J.C., Autschbach, F., et al.: Clinical practice guideline on diagnosis and treatment of Crohn’s disease. Z. Gastroenterol. 46, 1094–1146 (2008)PubMedCrossRefGoogle Scholar
  19. 19.
    Federal Statistical Office: Diagnosis data of patients in hospitals 2006, Fachserie 12 Reihe 6.2.1. Wiesbaden (2008)Google Scholar
  20. 20.
    InEK GmbH—Institute for the Hospital Remuneration System: G-DRG Definition Handbook, Version 2007. Siegburg (2006)Google Scholar
  21. 21.
    Federal Association of Local Health Care Funds: Overview of the case values in the single federal states (2007)Google Scholar
  22. 22.
    InEK GmbH—Institute for the Hospital Remuneration System: Diagnosis Related Group-Catalogue 2007 (2006)Google Scholar
  23. 23.
    LAUER-FISCHER GmbH. Lauer-Taxe online (www.lauer-fischer.de)
  24. 24.
    Dodd, S., Bassi, A., Bodger, K.: A comparison of multivariable regression models to analyse cost data. J. Eval. Clin. Pract. 12, 76–86 (2006)PubMedCrossRefGoogle Scholar
  25. 25.
    Nixon, R.M., Thompson, S.G.: Parametric modelling of cost data in medical studies. Stat. Med. 23, 1311–1331 (2004)PubMedCrossRefGoogle Scholar
  26. 26.
    O’Hagan, A., Stevens, J.W.: Assessing and comparing costs: how robust are the bootstrap and methods based on asymptotic normality? Health Econ. 12, 33–49 (2003)PubMedCrossRefGoogle Scholar
  27. 27.
    Briggs, A., Nixon, R., Dixon, S., et al.: Parametric modelling of cost data: some simulation evidence. Health Econ. 14, 421–428 (2005)PubMedCrossRefGoogle Scholar
  28. 28.
    Gibson, T.B., Ng, E., Ozminkowski, R.J., et al.: The direct and indirect cost burden of Crohn’s disease and ulcerative colitis. J. Occup. Environ. Med. 50, 1261–1272 (2008)PubMedCrossRefGoogle Scholar
  29. 29.
    Hillson, E., Dybicz, S., Waters, H.C., et al.: Health care expenditures in ulcerative colitis: the perspective of a self-insured employer. J. Occup. Environ. Med. 50, 969–977 (2008)PubMedCrossRefGoogle 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 131, 719–728 (2006)PubMedCrossRefGoogle Scholar
  31. 31.
    Yu, A.P., Cabanilla, L.A., Wu, E.Q., et al.: The costs of Crohn’s disease in the United States and other Western countries: a systematic review. Curr. Med. Res. Opin. 24, 319–328 (2008)PubMedCrossRefGoogle Scholar
  32. 32.
    Odes, S.: How expensive is inflammatory bowel disease? A critical analysis. World J. Gastroenterol. 14, 6641–6647 (2008)PubMedCrossRefGoogle Scholar
  33. 33.
    Kappelman, M.D., Rifas-Shiman, S.L., Porter, C.Q., et al.: Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology 135, 1907–1913 (2008)PubMedCrossRefGoogle Scholar
  34. 34.
    Henriksen, M., Jahnsen, J., Lygren, I., et al.: Clinical course in Crohn’s disease: results of a five-year population-based follow-up study (the IBSEN study). Scand. J. Gastroenterol. 42, 602–610 (2007)PubMedCrossRefGoogle Scholar
  35. 35.
    Solberg, I.C., Lygren, I., Jahnsen, J., et al.: Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand. J. Gastroenterol. 44, 431–440 (2009)PubMedCrossRefGoogle Scholar
  36. 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
  37. 37.
    Brechmann, T., Schmiegel, W.: Procedure of implementation of new methods of examination and treatment in the G-DRG system (NUB procedure). Med. Klin. (Munich) 102, 683–684 (2007)CrossRefGoogle Scholar
  38. 38.
    von der Schulenburg, J.-M., Greiner, W., Jost, F., et al.: German recommendations on health economic evaluation: third and updated version of the Hanover consensus. Value Health 11, 539–544 (2008)CrossRefGoogle Scholar
  39. 39.
    Häussler, B., Höer, A., Hempel, E. et al.: Arzneimittel-Atlas 2009: Der Arzneimittelverbrauch in der GKV. Munich. (2009)Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Anne Prenzler
    • 1
    Email author
  • Bernd Bokemeyer
    • 2
  • J.-Matthias von der Schulenburg
    • 1
  • Thomas Mittendorf
    • 1
  1. 1.Leibniz University Hannover, Center for Health EconomicsHannoverGermany
  2. 2.Gastroenterology Practice MindenMindenGermany

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