Burden of Crohn’s disease: economics and quality of life aspects in Italy

Abstract

Viviano Benedini,1 Nicola Caporaso,2 Gino Roberto Corazza,3 Zaccaria Rossi,4 Giovanni Fornaciari,5 Mario Cottone,6 Giorgio Frosini,7 Mauro Caruggi,8 Chiara Ottolini,8 Giorgio L Colombo9,10 On behalf of the COSMO Study Group1Department of Gastroenterology, AO Carlo Poma, Mantova; 2Department of Gastroenterology, University of Naples, Federico II, Naples; 3IRCCS Policlinico San Matteo, Pavia; 4Department of Gastroenterology, Ospedale Regina Apostolorum, Albano Laziale, Rome; 5Department of Gastroenterology, Arcispedale S Maria Nuova, Reggio Emilia; 6Medical Division, Azienda Ospedaliera Cervello, Palermo; 7Department of Gastroenterology, Policlinico Universitario Senese, Siena; 8Hospital S Antonio Abate, Gallarate, Varese, 9University of Pavia; School of Pharmacy, Pavia, Lombardy; 10Studi Analisi Valutazioni Economiche (SAVE), Milan, ItalyBackground: This was a prospective observational study designed to evaluate direct and indirect costs and quality of life for patients with Crohn’s disease in Italy from the perspectives of the National Health System and of society.Methods: A total of 162 male and female subjects aged 18–70 years with Crohn’s disease in the active phase and a Crohn’s Disease Activity Index score ≥150 were included in the study. Subjects were recruited from 25 Italian centers on a consecutive basis. The study consisted of four visits undertaken every 6 months with a follow-up period of 18 months. The study started on September 1, 2006 and was completed on April 12, 2010. Multivariate analyses were carried out on demographic characteristics, treatment costs based on the prescribed daily dose, resource use and other cost parameters, and changes in quality of life using the EQ5D questionnaire.Results: Cost of illness per subject with Crohn’s disease in Italy was estimated to be €15,521 per year, with direct costs representing 76% of total costs. Nonhealth care costs and loss of productivity accounted for 24% of total costs. Societal costs during the first months of enrolment were higher compared with costs in the final months of the study. Quality of life measured by the EQ-5D was 0.558 initially and then increased to 0.739, with a mean value of 0.677 during the enrolment period. The cost of illness was not correlated with age or gender.Conclusion: The cost of illness was correlated with quality of life; Crohn’s disease had a negative impact on subjects’ quality of life, and higher costs corresponded to a lower quality of life as measured with the EQ5D. Drug treatment may improve quality of life and reduce hospitalization costs. Our results appear to be in line with the results of other international cost-of-illness studies.Keywords: Crohn’s disease, quality of life, EuroQol, EQ5D, cost-of-illness, cost analysis, economic evaluation