Crohn’s Disease Treatment Expenditures over Fifteen Years of Follow-Up

Background: The increasing Crohn’s Disease (CD) prevalence worldwide has contributed to CD related healthcare resource use increase and the disease treatment has a considerable economic burden, varying between countries. The aim of this study was to assess the direct medical cost of CD treatment over fifteen years of follow up in Brazil.Methods: A total of 46,886 CD patients were included. Patients were identified from the Brazilian public health system databases between 2000 and 2014. The mean annual expenditure was calculated for each patient. Expenditures included the costs of all (CD-related or not) medications, diagnostics and monitoring exams, outpatient care and hospitalizations. Multivariate analyses were conducted to evaluate the relation between demographic and clinical variables in mean annual expenditure.Results: The total expenditures were US$ 844.24 million over the entire study period (2000-2014) with annual mean [95% CI] of US$ 3,451.0 [3,399.2-3,502.7] per patient. Of the total expenditures, 90.3% were for CD medications with Tumor Necrosis Factor inhibitors being the primary cost driver, accounting for 76.0% of the total – medication cost in 2000 and 85.9% in 2014. Hospitalization cost accounted for 3.0% of the overall total expenditures. The multivariate analyses showed that gender, age, region of residence, and medication used at study entry can predict DC treatment costs.Conclusion: In Brazil, the annual direct medical cost of CD treatment is substantial. Medication cost, in particular that of anti-TNF alpha agents is increasingly the most important cost driver.