Burden of Crohn’s disease: economics and quality of life aspects in Italy

Abstract

BackgroundThis was a prospective observational study designed to evaluate direct and indirect costs and quality of life for patients with Crohn’s disease in Italy from the perspectives of the National Health System and of society.MethodsA total of 162 male and female subjects aged 18–70 years with Crohn’s disease in the active phase and a Crohn’s Disease Activity Index score ≥150 were included in the study. Subjects were recruited from 25 Italian centers on a consecutive basis. The study consisted of four visits undertaken every 6 months with a follow-up period of 18 months. The study started on September 1, 2006 and was completed on April 12, 2010. Multivariate analyses were carried out on demographic characteristics, treatment costs based on the prescribed daily dose, resource use and other cost parameters, and changes in quality of life using the EQ5D questionnaire.ResultsCost of illness per subject with Crohn’s disease in Italy was estimated to be €15,521 per year, with direct costs representing 76% of total costs. Nonhealth care costs and loss of productivity accounted for 24% of total costs. Societal costs during the first months of enrolment were higher compared with costs in the final months of the study. Quality of life measured by the EQ-5D was 0.558 initially and then increased to 0.739, with a mean value of 0.677 during the enrolment period. The cost of illness was not correlated with age or gender.ConclusionThe cost of illness was correlated with quality of life; Crohn’s disease had a negative impact on subjects’ quality of life, and higher costs corresponded to a lower quality of life as measured with the EQ5D. Drug treatment may improve quality of life and reduce hospitalization costs. Our results appear to be in line with the results of other international cost-of-illness studies.

Indirect costs of inflammatory bowel diseases: Crohn’s disease and ulcerative colitis. A systematic review

“…We identified 4 studies presenting indirect costs associated with Crohn's disease [ 8 – 11 ], 4 studies for both Crohn's disease and ulcerative colitis [ 12 – 15 ], and 3 studies concerning inflammatory bowel disease in general [ 16 – 18 ], from the following countries: Italy [ 8 ], New Zealand [ 10 ], Germany [ 12 ], United Kingdom [ 13 ], Spain [ 9 ], Canada [ 18 ], Sweden [ 11 , 16 ], and United States of America [ 14 , 15 , 17 ]. Our systematic review showed that most of the data on Crohn's disease and ulcerative colitis came from Europe.…”

“…there was only information about national total indirect costs. Only in three studies was the methodology for the estimation of indirect costs specified, and these studies were included in further analysis [ 8 , 10 , 12 ]. The study by Lion et al .…”

“…The results of the study by Benedini et al . [ 8 ] are presented as total indirect costs, without the values for each cost category. Stark et al .…”

Health-Related Quality of Life Impairment and Indirect Cost of Crohn’s Disease: A Self-Report Study in Poland

“…The impact of disease severity on informal care was not assessed elsewhere, although Benedini et al [9] reported a correlation between the cost of relatives’ time loss with the quality of life among Italian patients with CD.…”

“…The impact of the severity of CD on the cost of productivity loss at unpaid work and the cost of informal care has not been investigated in detail, and only general information on impairment in usual activities, loss of leisure time, sick leave from paid work among caregivers, or time loss among relatives is available [6,9–13]. The inclusion of informal care can have a strong impact on cost-effectiveness outcomes.…”