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Disease-Associated Costs in Children With Inflammatory Bowel Disease: A Systematic Review
Wael El-Matary1,2, M Ellen Kuenzig3,4,5, Harminder Singh6
1Section of Pediatric Gastroenterology, Department of Pediatrics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Inflammatory bowel disease (IBD) in children and young adults incurs substantial direct and indirect costs, significantly exceeding those in non-IBD populations. Medication costs, particularly anti-TNF agents, are now the leading direct expense, shifting from past hospitalization focus.
Area of Science:
- Pediatric Gastroenterology
- Health Economics
- Systematic Review Methodology
Background:
- Inflammatory bowel disease (IBD) is a chronic, noncurable condition often diagnosed in childhood or adolescence.
- IBD imposes a significant lifetime financial burden on patients and healthcare systems.
- Understanding disease-associated costs in pediatric and young adult populations is crucial for resource allocation and patient support.
Purpose of the Study:
- To systematically review and determine the direct and indirect disease-associated costs of inflammatory bowel disease (IBD) in children and young adults (≤19 years).
- To identify key cost drivers and predictors of high healthcare expenditures in pediatric IBD populations.
Main Methods:
- A systematic literature review was conducted adhering to PROSPERO protocol CRD2016036128.
- Studies reporting direct health services costs or indirect economic burden in individuals aged 19 years or younger were included.
- Expert panels in pediatric gastroenterology and research methodology guided the review process.
Main Results:
- Nine studies met inclusion criteria, assessing direct, indirect, and out-of-pocket (OOP) costs.
- IBD-associated costs were significantly higher than in non-IBD populations, with substantial variability precluding meta-analysis.
- Direct costs shifted from inpatient care to medications, notably anti-tumor necrosis factor (anti-TNF) agents.
- Crohn's disease incurred higher costs than ulcerative colitis.
- High costs were associated with uncontrolled disease, recent corticosteroid use, and comorbidities.
Conclusions:
- The pediatric literature on IBD-attributable costs is limited and exhibits wide variations in estimates.
- Significant knowledge gaps exist regarding the indirect costs and OOP expenses associated with pediatric IBD.
- Further research is needed to comprehensively understand the economic burden of IBD in young individuals.
Background:
As a chronic noncurable disorder often diagnosed in childhood or adolescence, inflammatory bowel disease (IBD) confers a significant financial lifetime burden. The objective of this systematic review was to determine the disease-associated costs (both direct and indirect) associated with IBD in children and young adults.
Methods:
We conducted a systematic review of the literature and included any study reporting direct health services-related costs or the indirect economic burden of IBD in persons aged ≤19 years (PROSPERO protocol number CRD2016036128). A technical panel of experts in pediatric gastroenterology and research methodology formulated the review questions, reviewed the search strategies and review methods, and provided input throughout the review process.
Results:
Nine studies met criteria for inclusion, 6 of which examined direct costs, 1 of which examined both direct and indirect costs, 1 of which assessed indirect costs, and 1 of which assessed out-of-pocket (OOP) costs. Inflammatory bowel disease-associated costs were significantly higher compared with costs in non-IBD populations, with wide variations in cost estimates, which prevented us from conducting a meta-analysis. Costs in Crohn's disease were higher than in ulcerative colitis. Overall, direct costs shifted from inpatient hospitalization as a major source of direct costs to medications, mainly driven by anti-tumor necrosis factor agents, as the leading cause of direct costs. Predictors of high costs included uncontrolled disease, corticosteroid treatment in the previous year, and comorbidity burden.
Conclusions:
The pediatric literature examining IBD-attributable costs is limited, with widely variable cost estimates. There is a significant knowledge gap in the research surrounding indirect costs and OOP expenses.
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