IBD Prevalence and Costs
Canada has one of the highest rates of inflammatory bowel disease (primarily Crohn’s disease and ulcerative colitis) in the world, affecting close to 1 in 150 individuals. We have conducted several studies on the unmet needs of those living with IBD and the results show that many individuals are still experiencing barriers to ongoing, timely care. Yet, the prevalence and cost to treat IBD continue to grow. New research from major universities in the Western provinces reveal what this looks like for adults living in Saskatchewan.1
In this retrospective population-based study, the authors used health data between the fiscal years of 1999/2000 and 2016/2017. This includes hospital discharges, medical services, prescription drug use, and information from their health registration system. To identify cases of IBD, the authors used the International Classification of Disease diagnosis codes for Crohn’s disease and ulcerative colitis. Individuals must have had several healthcare contacts with their diagnosis within two years or less of public coverage. They excluded people who received drug coverage through federal programs (i.e., First Nations, Inuit, and military) from the study. Other exclusions were over-the-counter medications, medications administered in hospital, and youth under 18 years-of-age.
Between 1999 and 2017, the prevalence of IBD in Saskatchewan increased at an average of 3.3% every year. This means that in 1999, 201 in 100,000 people received a Crohn’s disease diagnosis. In 2017, this increased to 375 in 100,000. For ulcerative colitis, 135 in 100,000 individuals received a diagnosis in 1999 and at the end of 2017, this jumped to 289 for every 100,000. IBD cases were higher among older age groups, such as those 50 years-of-age and older.
Cost
With no cure on the horizon or a single guaranteed treatment solution, IBD continues to be a costly and burdensome disease for individuals, their families and caregivers, and for our healthcare systems. The total direct healthcare cost of IBD in 1999 was $7.8 million and this jumped to $50.9 million in 2017, with adjustments for inflation for comparison purposes. They generated these totals from the average standard hospital stay and resource use from the Canadian Institute for Health Information, costs from physician services, and medication claims for Crohn’s disease and ulcerative colitis, with prices based on the Saskatchewan public formulary.
90% of the total direct healthcare costs for IBD are from prescription medications while the remaining 10% are from hospital and physician costs. The average prescription cost per person increased from $660 in 1999 to $6,530 in 2017. The authors point to Canada’s patchwork of public and private drug plans and lack of universal prescription drug coverage as contributing factors to the rising costs of medication. While the root of the problem is more complex, the federal government is making drastic changes to how they regulate the prices of medicine in Canada.
Biologics were also a major cost driver in later years. Before the era of biologics, hospitalizations and surgeries made up most of the expenses. However, they are less effective in stabilizing the disease compared to biologics. Despite more cases of IBD throughout the years, hospitalization costs stayed the same, which may support the effectiveness of biologics in reducing disease progression and hospitalization.
It’s worth noting that after 2017, the costs for biologic medicines has significantly reduced due to the introduction in many jurisdictions of biosimilars, so this could affect any follow-up comparisons once biosimilar switching policies are fully in place across Canada.
The study authors admit that they did not capture the cost of outpatient lab services, such as blood and stool samples, screening, and care provided by nurses and other healthcare professionals. This is a significant gap in their research. To develop a comprehensive understanding of IBD, they called for future studies to include these services and to evaluate the indirect costs of this disease across Canada.