Objective: This systematic literature review aimed to quantify the economic burden of moderate-to-severe ulcerative colitis (UC) in the European Union Five (EU5) and identify key drivers.

Methods: Systematic searches were conducted in October 2021 in MEDLINE, Embase, the Database of Abstracts of Reviews of Effects, and the National Health Service Economic Evaluation Database. Real-world studies published since 2010 reporting direct healthcare and indirect work-related costs and healthcare resource use (HCRU) among adults with moderate-to-severe UC in the EU5 were included. Two independent reviewers screened 2,206 unique records. Costs were converted to 2019 Euros.

Results: A total of 25 unique studies (31 publications) were included: 6 reported healthcare costs only, 8 reported HCRU only, and 11 reported costs and HCRU. Patient characteristics, interventions, study settings, and study years varied across studies.

Overall direct healthcare costs varied by treatment type and disease severity and were largely driven by prescription drug costs. Patients on advanced therapies such as anti-tumor necrosis factor agents, vedolizumab, or tofacitinib had higher direct costs (€24,552 - €34,068 per patient year [PPY] on stable dose vs. €39,514/PPY on escalated dose) than patients on non-biological treatments such as corticosteroids and/or immunosuppressants (€4,708 PPY for non-active disease vs. €8,655 PPY for active disease).

Moderate-to-severe UC patients with active disease reported significantly higher rates of absenteeism, presenteeism and overall work impairment (29.3% vs. 3.7%, p<0.05; 49.09% vs. 16.02%, p<0.05; and 54.35% vs. 19.38%, p<0.05) compared to those in remission. Introduction of advanced treatments is associated with a considerable reduction in both direct and indirect costs.

Conclusion: Moderate-to-severe UC has a significant impact on direct healthcare costs (outpatient, hospitalization, and prescription) and indirect work-related costs (absenteeism, presenteeism, and work productivity) in the EU5. There remains an unmet need for additional therapies that can further reduce the healthcare burden and impact on society.