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.