Background: There is limited longitudinal IBD healthcare cost data in the post-biologic era.
Aims: To calculate the direct healthcare costs in the first 4 years following diagnosis using two well characterized cohorts of recently diagnosed IBD patients from a population based and hospital based cohort in order to determine:
1) The total direct healthcare cost of IBD in the first 4 years.
2) The proportional change in IBD health care costs over time.
3) The change in mean IBD healthcare costs per patient over time.
4) If there is any difference in cost of care between a hospital and population-based IBD cohort.
Methods: From June 2007 to September 2016, newly diagnosed IBD cases were recruited from a tertiary referral center to form a hospital-based cohort, or a regional center to form a population-based cohort. Healthcare resource utilization and clinical data for each patient was collected. Total costs were calculated for investigations, specialist visits, medications, and hospitalization each 12 months from diagnosis to a maximum of 48 months.
Results: 353 IBD patients were recruited (171 Hospital, 182 Population). There were no significant differences in disease phenotype at diagnosis between each cohort.
1) Total direct cost: The total cost of care for the first 4 years was A$10,847,094. CD accounted for 70% of total cost. Medication expenditure accounted for 61% of total. Biologic medication cost accounted for 80% of total medication cost. Inpatient admissions accounted for 27% of total cost.
2) Change in health care costs over time: In the CD cohort, inpatient admissions accounted for 45% in the first 12 months compared with only 9% in months 36–48. Medication costs accounted for 40% in the first 12 months, but increased to 80% in months 36–48. In UC, inpatient medical admissions and surgical admissions accounted for 32% in the first 12 months compared with 21% in months 36–48. Medication costs accounted for 47% in the first 12 months, but increased to 68% in months 36–48.
3) The mean annual cost reduction from the 1st to the 4th year in CD was $4,011 per patient. The mean medication cost increased by $3,083 over this time. The mean cost reduction in the UC cohort was $4,022. There was no significant change in mean medication cost. All of the other healthcare costs reduced over time.
4) There was no significant difference in median cost of care for the first 4 years between the hospital-based cohort versus the population-based cohort in CD or UC.
Conclusions: The cost of care in IBD is driven by medication and inpatient admission costs. Over time, medical and surgical admission costs fall while the cost of medication increases. The cost of care is highest in the first year and reduces over time.