Inflammatory bowel disease (IBD) puts a significant burden on healthcare systems due to its chronic nature and expensive treatments. Back in 2004, the main direct cost of IBD care came from hospitalisations and surgery1. The approach to IBD care has progressed in the last 16 years, with a shift to more outpatient care, aided by the wider availability of expensive biologic drugs that can be effective in inducing and maintaining remission2,3, albeit at the risk of some side-effects. Changes in IBD therapy have improved the experience of many patients4, but it has been less apparent how the evolution in treatment has changed the economics of IBD care.
Recently, a large, multi-centre population-based study has offered an excellent new insight into the current costs of IBD in Europe5. Burisch et al. (Lancet. Gastroenterol. Hepatol) used the pan-European Epi-IBD cohort, prospectively collecting data on patient care over 5 years of follow up (costs included procedures leading to initial diagnosis, as well as management over 5 years). Of the 1289 patients, 38% had Crohn’s disease, 56% had ulcerative colitis and 6% had unclassified IBD.
The striking finding from this study is the hugely significant proportion of the cost of IBD care that now comes from biologic therapies. The mean cost per patient-year of follow-up was €3542 for Crohn’s disease, €2088 for ulcerative colitis and €1609 for IBD unclassified, with as much as 50% of that cost coming from biologics (in the case of Crohn’s disease, Fig. 1). Over the 5 years after diagnosis, the 1289 patients who were studied accumulated costs exceeding €13 million, of which a third was spent on biologics.