Systematic review: societal cost of illness of inflammatory bowel disease is increasing due to biologics and varies between continents

Abstract

Summary Background Knowledge of the cost of illness of inflammatory bowel disease (IBD) is essential for health policy makers worldwide. Aim To assess the cost of illness of IBD from the societal perspective taking into account time trends and geographical differences. Methods A systematic review of all population‐based studies on cost of illness of IBD published in Embase, Medline, Web of Science and Google Scholar. Methodology of included studies was assessed and costs were adjusted to 2018 US dollars. Results Study methodologies differed considerably, with large differences in perspective, valuation method and population. For prevalent Crohn's disease (CD) cases in the last ten years annual healthcare costs were in Asia $4417 (range $1230‐$31 161); Europe $12 439 ($7694‐$15 807) and North America $17 495 ($14 454‐$20 535). For ulcerative colitis (UC), these were $1606 ($309‐$14 572), $7224 ($3228‐$9779) and $13 559 ($13 559‐$13 559). The main cost driver was medication, the cost of which increased considerably between 1985 and 2018, while outpatient and inpatient costs remained stable. IBD had a negative impact on work productivity. Annual costs of absenteeism for CD and UC were in Asia (with presenteeism) $5638 ($5638‐$5638) and $4828 ($4828‐$4828); Europe $2660 ($641‐$5277) and $2394 ($651‐$5992); North America $752 ($307‐$1303) and $1443 ($85‐$2350). Conclusion IBD societal cost of illness is increasing, driven by growing costs of medication, and varies considerably between continents. While biologic therapy was expected to decrease inpatient costs by reducing hospitalisations and surgery, these costs have not declined.

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The future of drug development for inflammatory bowel disease: the need to ACT (advanced combination treatment)

“…However, price pressure due to biosimilars uptake of several biological drugs in clinical practice turns to be favourable within this perspective. Biological agents have radically changed the economic landscape of IBD driving an increasing percentage of associated costs initially, to be added to the high impact of disease burden on healthcare systems budgets due to hospitalisations, surgery, work disability and impaired quality of life 85 86. The introduction of biosimilars has resulted in significant cost savings and it is intuitive that increasing biosimilars and biobetters’ (meant as a modified version of a specific approved biologic) approval could enlarge the available therapeutic options and favour price erosion 87–89.…”

Low-dose naltrexone for the induction of remission in patients with mild to moderate Crohn’s disease: protocol for the randomised, double-blinded, placebo-controlled, multicentre LDN Crohn study

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“… 2 Further, the introduction of biologicals resulted in increased drug and societal costs. 3 The lifelong nature of CD increases the probability that patients have cycled through various therapies, leaving few approved options. Thus, alternative treatments that are less expensive and have a favourable side effect profile remain of continued interest.…”