The cost of Crohn's disease - Drugs or surgery?

Authors
Citation
Rd. Cohen, The cost of Crohn's disease - Drugs or surgery?, BIODRUGS, 14(5), 2000, pp. 331-344
Citations number
81
Categorie Soggetti
Pharmacology
Journal title
BIODRUGS
ISSN journal
11738804 → ACNP
Volume
14
Issue
5
Year of publication
2000
Pages
331 - 344
Database
ISI
SICI code
1173-8804(200011)14:5<331:TCOCD->2.0.ZU;2-S
Abstract
New biological medical therapies and innovative surgical approaches have re volutionised the care of patients with Crohn's disease. Until these innovat ions began to be utilised over the past decade, studies of the economics of Crohn's disease care were relatively scarce. Questions from both clinical and economic standpoints now arise over potential choices between medical a nd surgical approaches to patients with Crohn's disease. Initial economic studies suggested that the vast majority of costs in Crohn 's disease were due to inpatient services and surgery. The large variance i n cost data between patients resulted in a very small percentage of patient s accounting for a disproportionately large percentage of the overall costs , with the bulk of costs, charges and reimbursements accrued by surgical ca ses. Studies suggest that surgery would need to result in a decreased utili sation of outpatient services in order to be 'cost-effective'. Evaluation of the clinical course of Crohn's disease suggests that the surg ically-induced remission state is the longest remission slate generally exp erienced by the patients, although sophisticated cost analysis fails to sho w enough of a remission benefit to offset the high costs associated with su rgical procedures and post-operative convalescence. Bowel-sparing intestina l stricture-plasty and minimally invasive laparoscopic surgeries have the p otential to substantially decrease the costs associated with disease. These techniques need to be applied to a larger percentage of surgical Crohn's p atients before the overall economic benefits can be fully assessed. Indirect costs and disability may account for most of the overall costs ass ociated with Crohn's disease. Quality-of-life analyses have revealed that p atients ill with Crohn's disease perform poorly and the detrimental effects of medications or surgery may further increase disability in these patient s. Future cost-utility studies may reveal the extent to which overall costs are affected by these issues. This review of the currently available literature on the economics of Crohn 's disease suggests that medical therapy which can substantially reduce the utilisation of hospitalisations and surgery might be cost effective, even if the acquisition cost of the drug is high. However, broader application o f specialised surgical techniques, together with the long post-operative re mission state enjoyed by most Crohn's patients, may also offer a cost-effec tive long term approach to the disease. It is likely that both surgical and medical approaches will continue to be used in the treatment of Crohn's di sease, with options for each patient being carefully considered on an indiv idual basis.