Inflammatory bowel disease: a Canadian burden of illness review

Abstract

Background: Inflammatory bowel diseases (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) - significantly impact quality of life and account for substantial costs to the health care system and society.

Objective: To conduct a comprehensive review and summary of the burden of IBD that encompasses the epidemiology, direct medical costs, indirect costs and humanistic impact of these diseases in Canada.

Methods: A literature search focused on Canadian data sources. Analyses were applied to the current 2012 Canadian population.

Results: There are approximately 233,000 Canadians living with IBD in 2012 (129,000 individuals with CD and 104,000 with UC), corresponding to a prevalence of 0.67%. Approximately 10,200 incident cases occur annually. IBD can be diagnosed at any age, with typical onset occurring in the second or third decade of life. There are approximately 5900 Canadian children <18 years of age with IBD. The economic costs of IBD are estimated to be $2.8 billion in 2012 (almost $12,000 per IBD patient). Direct medical costs exceed $1.2 billion per annum and are driven by cost of medications ($521 million), hospitalizations ($395 million) and physician visits ($132 million). Indirect costs (society and patient costs) total $1.6 billion and are dominated by long-term work losses of $979 million. Compared with the general population, the quality of life patients experience is low across all dimensions of health.

Conclusions: The present review documents a high burden of illness from IBD due to its high prevalence in Canada combined with high per-patient costs. Canada has among the highest prevalence and incidence rates of IBD in the world. Individuals with IBD face challenges in the current environment including lack of awareness of IBD as a chronic disease, late or inappropriate diagnosis, inequitable access to health care services and expensive medications, diminished employment prospects and limited community-based support.

Figures

Figure 1)

Prevalence per 100,000 population according to province. Data adpated from references and . AB Alberta; BC British Columbia; CD Crohn’s disease; CDN Canadian; excl Excluding; incl Including; MB Manitoba; NS Nova Scotia; SK Saskatchewan; UC Ulcerative colitis

Figure 2)

Prevalence of inflammatory bowel disease (Crohn’s disease [CD], Ulcerative colitis [UC]) according to province in 2012. Prevalences directly estimated from the Canadian IBD Epidemiology Database study for British Columbia, Alberta, Saskatchewan, Manitoba and Nova Scotia, and from reference for Quebec; extrapolated for Newfoundland and Labrador, Prince Edward Island, New Brunswick, Ontario and the Territories

Figure 3)

Direct costs of inflammatory bowel disease in Canada in 2012

Figure 4)

Indirect costs of inflammatory bowel disease, Canada 2012

Figure 5)

Utility scores for Crohn’s disease versus the general population