Silverstein, M. D. et al. Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort. Gastroenterology 117, 49-57

Division of Area General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Gastroenterology (Impact Factor: 16.72). 08/1999; 117(1):49-57. DOI: 10.1016/S0016-5085(99)70549-4
Source: PubMed


Crohn's disease results in substantial morbidity and high use of health services. The aim of this study was to describe the lifetime clinical course and costs of Crohn's disease in a 24-year population-based inception cohort of patients with Crohn's disease in Olmsted County, Minnesota.
Disease states were defined by medical and surgical treatment. A Markov model analysis calculated time in each disease state and present value of excess lifetime costs in comparison with an age- and sex-matched cohort.
For a representative patient, projected lifetime costs were $39,906 per patient using median charges and $125,404 using mean charges. There were 29.1 years (63% of total) without medications. There were 12.7 years (27%) on aminosalicylate therapy, generating $11,467 (29%) in charges, and 3.2 years (7%) on corticosteroid or immunosuppressive therapy, generating $5147 (13%) in charges. Surgery generated $17,526 (44%) in charges.
Most of the clinical course is spent in remission, either medical or surgical. Aminosalicylate therapy accounts for 29% of the costs of care. Surgery has the highest charges but the longest remissions. Treatment strategies that induce remission in mild disease and maintain remission with lower-cost maintenance therapy will have the largest effect on patient outcomes and costs.

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    • "A Canadian study105 showed that general medical inpatient costs for CD and UC were identical, but surgical costs were more for those patients with UC than those with CD. A larger proportion of total charges for IBD were therefore attributable to surgical care.26 These two studies, however, which were reported over two decades ago, did not take into account the impact of biologics such as infliximab, adalimumab, certolizumab pegol and natalizumab on the current medical options for IBD. "
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    • "More recently the incidence rate and the prevalence of Crohn's disease were estimated at 3.6 to 15.6 cases per 100,000 persons and 26 to 201 cases per 100,000 persons in North America (Loftus 2004; Kappelman et al. 2007). Silverstein et al. (1999) "
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