BackgroundAlthough the costs of treating inflammatory bowel disease (IBD) in developed countries are well established, they remain largely unknown in countries with recent histories of socio-economic transition including Serbia.ObjectiveTo estimate the costs of treatment including the resources used by patients with IBD in Serbia from a societal perspective. This includes both Crohn’s disease and ulcerative colitis.MethodsThis cost-of-illness study was conducted to identify direct, indirect and out-of-pocket costs of treating patients with IBD in Serbia. Patients with IBD (n = 112) completed a semi-structured questionnaire with data concerning their utilisation of heath-care resources and illness-related expenditures. All costs were calculated in Republic of Serbia dinars (RSD) at a 1-year level (2014) and subsequently converted to Euros. Median values and ranges were reported to avoid potential distortions associated with mean costs.ResultsMedian total direct costs and total indirect costs per patient per year in patients with Crohn’s disease were 192,614.32RSD (€1602.97) and 28,014.00RSD (€233.13) and 142,267.15RSD (€1183.97) and 21,436.00RSD (€178.39), respectively, in patients with ulcerative colitis. In both groups, the greatest component of direct costs was hospitalisation.ConclusionsCosts of IBD in Serbia are lower than in more developed countries for two reasons. These include the fact that expensive biological therapy is currently under-utilised in Serbia and prices of health services are largely controlled by the State at a low level. The under-utilisation of biologicals may change with the advent of biosimilars at increasingly lower prices.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-016-0272-z) contains supplementary material, which is available to authorized users.

The most prevalent symptoms at baseline were abdominal pain (85.3%), constipation (7.5%) and bloating (76.5%). Mean IBS-QoL was 61.8±18.2 (scale: 0-100 [worst-best]). Mean EQ-5D was 58.4±20.2 (scale: 0-100 [worst-best]) and 85.3% and 50.9% of patients reported moderate-to-severe problems in pain/discomfort and anxiety/depression, respectively. Over the year, 78.4% patients consulted a primary care physician and 69.6% a gastroenterologist, 18.6% patients required emergency department visits/hospitalisation and 66.7% had a diagnostic test. 54.9% patients took prescription drugs for their IBS-C and 69.6% took non-prescription drugs. Mean (95%CI) annual direct costs per patient for Germany's national healthcare system: