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01-08-2006 | Original Research Article

Costs of Inflammatory Bowel Disease in Germany

Authors: Renee Stark, Hans-Helmut König, Reiner Leidl

Published in: PharmacoEconomics | Issue 8/2006

Abstract

Introduction: Inflammatory bowel disease (IBD) is a chronic condition that afflicts young adults in their economically productive years. The goal of this study was to determine the costs of IBD in Germany from a societal perspective, using cost diaries.

Methods: Members of the German Crohn’s Disease and Ulcerative Colitis Association who had IBD were recruited by post, and those who agreed to participate documented their IBD-associated costs prospectively in a diary over 4 weeks. They documented their use of healthcare facilities, medications, sick leave and out-of-pocket expenditures, as well as general demographic information, the status and history of their IBD, and long-term disability. Item costs were calculated according to national sources. Cost data were calculated using non-parametric bootstrapping and presented as mean costs (year 2004) over 4 weeks.

Results: The cost diaries were returned by 483 subjects (Crohn’s disease: n = 241, ulcerative colitis: n = 242) with a mean age of 42 years and an average disease duration of 13 years (SD ± 8.09). The cost diaries were regarded as ‘easy to complete’ by 89% of participants. The mean 4-week costs per subject were €1425 (95% CI 1201, 1689) for Crohn’s disease and €1015 (95% CI 832, 1258) for ulcerative colitis. Of the total costs for Crohn’s disease, 64% were due to indirect costs such as early retirement or sick leave and 32% were due to direct medical costs. In contrast, of the total costs for ulcerative colitis, 41% were due to direct medical costs and 54% to indirect costs.

Conclusions: This is the first comprehensive cost study for Crohn’s disease and ulcerative colitis in Germany. The most important economic factors that influenced the cost profiles of both diseases were the long-term productivity losses due to an ongoing inability to work and the cost of medications. Results indicate significant cost differences between Crohn’s disease and ulcerative colitis. This data provides initial cost estimates that can be analysed further with respect to cost determinants and disease-specific costs in the future.

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Patients were asked to specify costs per week for each of the ‘non-physician medical services’. For visits to a healer, physiotherapist or masseur, the costs documented by patients were compared with those available from the billing catalogue. If the costs were less than those of the billing catalogue, it was assumed that the patient had documented the co-payment, since patients insured with statutory health insurance must only pay a co-payment if a medical service has been prescribed by their physician (thus they would not know the real billing price). In this case, the price of the service according to the billing catalogue was taken. However, if the costs documented were higher than the billing catalogue, the value documented by the patient was used. Services that are not prescribed, and those used by privately insured patients, must be paid directly.

Secondary general school, intermediate school and grammar school are the three types of school that can be attended after grade 4 in Germany, all starting at grade 5.[41] If a student only attends secondary general school without further qualifications, they can only go on to do an apprenticeship, whereas from intermediate school, a student can go on to further training for medium level occupations (e.g. bank employee) or obtain further qualifications for technical institutes. Only students attending grammar school can go on to study at university. Thus, table II provides only information regarding schooling up to grades 10–13 and the text provides some extra information regarding further training, such as trade school and university, which is comparable to other countries.

Welfare payments, which are paid from taxes, differ from the pension received by 19% of patients with Crohn’s disease and 17% of patients with ulcerative colitis. These pensions are paid by the pension fund for long-term disability. Individuals can only receive such a disability pension if they have paid into the fund (i.e. were employed), are not eligible for the retirement pension and the courts have granted them the pension based on an expert medical report.

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Title: Costs of Inflammatory Bowel Disease in Germany
Authors: Renee Stark
Hans-Helmut König
Reiner Leidl
Publication date: 01-08-2006
Publisher: Springer International Publishing
Published in: PharmacoEconomics / Issue 8/2006
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200624080-00006

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Costs of Inflammatory Bowel Disease in Germany

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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