Resource Utilization and Costs Related to Inflammatory Bowel Disease: A Longitudinal Analysis Based on Routine Data from Two German Statutory Health Insurance Providers

OBJECTIVES: Inflammatory bowel disease (IBD) commonly starts in young age and results in constrained quality of life and high resource utilization over the life course. Therefore, the aim of the study was to identify societal and economic implications for improvements based on real-world data.

METHODS: Routine data from two German health insurances with around 30,000 insured were descriptively analyzed for the years 2015-2021 regarding the incidence and prevalence of IBD, inability to work, hospitalization, drug therapy and related costs. Where necessary, data of insured diagnosed with and without IBD or the German national average were compared and stratified between ulcerative colitis (UC) as well as Crohn’s disease (CD). The data were prepared with SQL and analyzed with R.

RESULTS: Around 300 insured (39% males; 61% females) with a confirmed diagnosis of IBD and a mean age of 50 years were identified. An incidence of 0.07% and a prevalence of 1.11% was calculated, which is higher compared to the literature. Insured diagnosed with IBD were longer unable to work (19 vs. 11 days) and stayed longer in hospital (12 vs. 7 days) compared to the German national average. Mesalazine accounted for 78% of prescriptions for UC patients and 42% of prescriptions for CD patients. Only 7% of prescriptions for UC were for TNF-alpha inhibitors. UC patients stayed long on mesalazine and switched rarely to TNF-alpha inhibitors alone (1%), while 3.5% of them received combination therapy of both. TNF-alpha inhibitors had the highest share of drug costs and average costs per patient were 25 times higher compared to mesalazine.

CONCLUSIONS: Therapy with proven effective mesalazine is well accepted in real world prescribing practice for most IBD patients. To improve patient outcomes and reduce costs, patient-centered clinical pathways and guideline-recommended remission maintenance with mesalazine in UC are recommended.