Journal of Peking University(Health Sciences) >
Economic burden and factors associated with Crohn’s disease
Received date: 2021-03-01
Online published: 2021-06-16
Objective: To study the economic burden of Crohn’s disease and its related factors, and to provide opinions for reducing personal burden and improving reimbursement policy. Methods: Using a cross-sectional method, a self-created questionnaire based on the basic principles of health services research was used to survey Crohn’s disease patients served by the Shanghai volunteer service foundation platform. Information collected included basic characteristics, therapy, and medical costs related to Crohn’s disease in the past 12 months. Descriptive statistics were used to analyse the composition of inpatient and outpatient costs of Crohn’s disease for treatment of the disease in the past year. Further, a logarithm-linear model was constructed to analyse the factors associated with the financial burden of Crohn’s disease. Results: In the study, 820 questionnaires were distributed and 799 questionnaires were returned, of which 797 were valid. There were 528 (66.25%) males and 269 (33.75%) females. The mean age of the patients was (34.02±11.49) years, with a concentration between 18-39 years (510 cases, 63.99%) and a mean disease duration of (5.58±5.13) years. 10.7% of the patients did not receive continuous treatment, and the average annual treatment cost for the patients with continuous treatment was 54 246 Yuan, of which 30 279 Yuan (55.8%) was paid by the individuals and 23 966 Yuan (44.2%) was paid by the insurance. The personal financial burden was close to the national per capita disposable income in 2020, which was 32 189 Yuan (94.1%), exceeding the annual cost for type 2 diabetes in China in 2016, 8 245 Yuan. In terms of the distribution of outpatient and inpatient services, the average annual cost of inpatient services was 31 092 Yuan, of which 14 673 Yuan (48.5%) was paid out of pocket by the individuals and 16 418 Yuan (51.5%) was paid by the insurance; the average annual cost of outpatient services was 23 154 Yuan, of which 15 606 Yuan (65.1%) was paid out of po-cket by the individuals and 7 548 Yuan (34.9%) was paid by the insurance. The personal burden of outpatient care was higher than of inpatient care. The regression results of the logarithm-linear model showed that the total annual treatment cost was related to the duration of illness (β=0.03, P<0.01), having complications (β=-0.68, P<0.01), receiving surgical treatment (β=0.52, P<0.01), using immunosuppressive drugs (β=0.51, P<0.01), annual outpatient visits (β=0.02, P<0.05), and number of hospitalizations per year (β=0.08, P<0.01). Conclusion: The annual financial burden for patients with Crohn’s disease is heavy and rises significantly with the duration of illness, exceeding that of chronic diseases such as diabetes. The personal financial burden is close to the national per capita disposable income, and the medical security department should develop policies to reduce the financial burden. The inclusion of Crohn’s disease as a special outpatient disease is a possible measure that could be considered in response to the fact that the outpatient personal financial burden is heavier than the inpatient’s.
Key words: Crohn’s disease; Cost of illness; Health care costs; Health policy
Wu-ping ZHOU , Nan MU , Wei-yan JIAN , Hua-hong WANG . Economic burden and factors associated with Crohn’s disease[J]. Journal of Peking University(Health Sciences), 2021 , 53(3) : 555 -559 . DOI: 10.19723/j.issn.1671-167X.2021.03.019
| [1] | 吴开春, 梁洁, 冉志华, 等. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中国实用内科杂志, 2018,38(9):796-813. |
| [2] | Adamina M, Bonovas S, Raine T, et al. ECCO guidelines on therapeutics in Crohn’s disease: Surgical treatment[J]. J Crohns Colitis, 2020,14(2):155-168. |
| [3] | 中华医学会消化病学分会炎症性肠病学组, 中华医学会肠外与肠内营养学分会胃肠病与营养协作组. 炎症性肠病营养支持治疗专家共识(第二版)[J]. 中华炎性肠病杂志(中英文), 2018,2(3):154-172. |
| [4] | Lichtenstein GR, Shahabi A, Seabury SA, et al. Lifetime economic burden of Crohn’s disease and ulcerative colitis by age at diagnosis[J]. Clin Gastroenterol Hepatol, 2020,18(4):889-897. |
| [5] | Yu Q, Zhu C, Feng S, et al. Economic burden and health care access for patients with inflammatory bowel diseases in China: Web-based survey study[J]. J Med Internet Res, 2021,23(1):e20629. |
| [6] | Mak WY, Zhao M, Ng SC, et al. The epidemiology of inflammatory bowel disease: East meets west[J]. J Gastroenterol Hepatol, 2020,35(3):380-389. |
| [7] | Ng SC, Leung WK, Shi HY, et al. Epidemiology of inflammatory bowel disease from 1981 to 2014: Results from a territory-wide population-based registry in Hong Kong[J]. Inflamm Bowel Dis, 2016,22(8):1954-1960. |
| [8] | Pellino G, Keller DS, Sampietro GM, et al. Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn’s disease[J]. Tech Coloproctol, 2020,24(5):421-448. |
| [9] | Torres J, Bonovas S, Doherty G, et al. ECCO guidelines on therapeutics in Crohn’s disease: Medical treatment[J]. J Crohns Colitis, 2020,14(1):4-22. |
| [10] | Wang YF, Ouyang Q, Hu RW. Progression of inflammatory bowel disease in China[J]. J Dig Dis, 2010,11(2):76-82. |
| [11] | Ng SC, Kaplan GG, Tang W, et al. Population density and risk of inflammatory bowel disease: A prospective population-based study in 13 countries or regions in Asia-Pacific[J]. Am J Gastroenterol, 2019,114(1):107-115. |
| [12] | Chen H, Shi J, Pan Y, et al. Cost-effectiveness of reimbursing infliximab for moderate to severe Crohn’s disease in China[J]. Adv Ther, 2020,37(1):431-449. |
| [13] | Mao W, Yip CW, Chen W. Complications of diabetes in China: Health system and economic implications[J]. BMC Public Health, 2019,19(1):269. doi: 10.1186/s12889-019-6569-8. |
| [14] | 李春燕, 简伟研. 中老年人心血管疾病经济负担——基于中国健康与养老追踪调查的实证分析[J]. 中国卫生政策研究, 2017,10(5):75-80. |
| [15] | 袁鸿绯, 郑武, 徐根荣. 台州市区职工医保特殊病门诊支出分析[J]. 中国医疗保险, 2017(10):54-58. |
| [16] | 段承阿鑫, 常峰, 路云. 我国各省城镇职工基本医疗保险门诊特殊疾病政策比较研究[J]. 中国卫生事业管理, 2017,34(5):342-345. |
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