The costs of Crohn's disease in the United States and other Western countries: a systematic review

Objective: To conduct a critical and systematic literature review of the costs of Crohn's disease (CD) in Western industrialized countries. Research design and methods: Studies published in English that described the cost of CD in Western industrialized countries were identified using three major databases (Medline, EMBASE, and ISI Web of Science). Studies were reviewed and rated based on their relevance to cost of illness and the reliability of the estimates. All costs were adjusted for inflation to 2006 values. Results: Estimated direct medical costs were $18 022-18 932 per patient with CD per year in the United States, and (sic)2898-6960 in other Western countries. Hospitalizations accounted for 53-66% of direct medical costs, with an average cost-per-hospitalization of $37459 in the United States. Estimated indirect costs accounted for 28% of the total cost in the United States and 64-69% in Europe. Costs differed greatly by disease severity. Costs of patients with severe disease were 3- to 9-fold higher than patients in remission. Direct medical costs in the United States for patients in the top 25% of total costs averaged $60 582 per year; costs of patients in the top 2% averaged more than $300000 per year. Combining prevalence rates, the total economic burden of CD was $10.9-15.5 billion in the United States and (sic)2.1-16.7 billion in Europe. Limitations: This review is limited by the research quality and variations of the individual studies reviewed, and only includes English articles. Conclusions: This updated literature synthesis demonstrated the substantial total cost burden of CD, of which hospitalizations accounted for more than half of direct medical costs.