Resource use and societal costs for Crohn's disease in Sweden

The usual onset of Crohn's disease (CD) is between 15 and 30 years of age, thus affecting people during their most economically productive period in life.

This study intended to estimate societal costs and health-related quality of life (HRQoL) in Swedish patients in different stages of CD. Cross-sectional data on disease activity (measured with the Harvey-Bradshaw Index [HBI]), direct medical resource use, work productivity, and HRQoL (assessed using the 15D instrument) were collected for 420 patients by questionnaires to patients, to the treating physician, and from medical records. Based on HBI, current treatment, and response to treatment, patients were classified into the following disease states: Remission, Response, Active, Refractory, and Surgery.

The average 4-week cost per patient in 2007 was estimated at €721 (USD 988), of which 64% was due to lost productivity. The total 4-week cost of care was €255 (USD 349) in Remission, €831 (USD 1138) in Response, €891 (USD 1220) in Active, €1360 (USD 1864) in Refractory, and €16984 (USD 23269) in Surgery. HBI was the most important predictor of costs of care--a 1-point increase in HBI increased total costs by 25% (P < 0.001). HRQoL differed between the disease states: 0.92 in Remission, 0.90 in Response, 0.82 in Active, 0.81 in Refractory, and 0.77 in Surgery.

Patients in remission have the lowest costs and the highest HRQoL. Patients responding to treatment have lower costs of care than patients with high disease activity who are not treated or do not respond to treatment. Thus, total costs of care might be reduced by efficient treatment.