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Abstract
The aim of this systematic review was to collect all current data on indirect costs related to inflammatory bowel disease as well as assessing homogeneity and comparability, and conducting a meta-analysis. Costs were collected using databases from Medline, Embase and Centre for Reviews and Dissemination databases, then average annual cost per patient was calculated and expressed in 2013-rate USD using the consumer price index and purchasing power parity (scenario 1) and then adjusted to specific gross domestic product (scenario 2) to make them comparable. The studies were then included in quantitative synthesis using the meta-analysis and bootstrap methods. This systematic review was carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. From 18 publications, overall annual indirect costs per patient as a result of the quantitative synthesis among all studies eligible for meta-analysis ranged from US$2425.01–US$9622.15 depending on the scenario and model used for analysis. The cost of presenteeism was assessed in only two studies. Considering heterogeneity among all identified studies random-effect model presented the most accurate results of meta-analysis equal to US$7189.27 and US$9622.15 per patient per year for scenario 1 and scenario 2, respectively. This systematic review revealed the existence of a relatively small number of studies that reported on the great economic burden of the disease upon society. A great variety of methodologies and cost components resulted in a very large discrepancy in indirect costs and made meta-analysis difficult to perform, so two scenarios were considered and meta-analysis conducted in subgroups to make data more comparable.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Crohn’s disease and ulcerative colitis are two idiopathic inflammatory bowel disorders causing abdominal pain, fever, and clinical signs of bowel obstruction or diarrhea with the passage of blood or mucus, or both.
Inflammatory bowel diseases cause a great decrease in the quality of life and place a huge socioeconomic burden in the form of absenteeism and presenteeism.
The small amount of identified studies and great variety of considered components on indirect costs, macroeconomic indicators and methodologies shows that this issue has not yet been fully examined.
There is a great need of further studies focused on indirect costs in inflammatory bowel diseases to make it possible to include the societal perspective into cost–effectiveness/utility analyses.
Indirect cost data are difficult to analyze. Converting the data into 2013 USD made it more comparable and made further quantitative synthesis possible.
The annual indirect cost per patient ranges from US$515.67 to US$14,727.05 for scenario 1 and from US$532.99 to US$25,194.92 for scenario 2.
Meta-analysis showed that for scenario 1 the overall annual indirect costs per patient ranged from US$2425.01 to US$7189.27, and for scenario 2, the overall annual indirect costs per patient ranged from US$3733.00 to US$9622.15.