Health-related quality of life outcomes and economic burden of inflammatory bowel disease in Japan

Figures & data

Table 1 Comparison of demographics and health characteristics between patients with IBD and controls

Parameters		Bivariate comparisons – unweighted			Bivariate comparisons – weighted
		IBD n=441	Control n=82,944	P-value	IBD n=441	Control n=428	P-value
Age (mean ± SD/SE)	Years	48.2±14.8	47.5±15.6	0.351	48.2±0.7	48.6±0.2	<0.001
Sex (count [%])	Male	272 (61.7%)	41,930 (50.6%)	<0.001	272 (61.7%)	257 (60.0%)	0.481
Currently employed (count [%])	Yes	292 (66.2%)	50,259 (60.6%)	0.016	292 (66.2%)	278 (65.1%)	0.618
University education (count [%])	Less than university education	224 (50.8%)	42,955 (51.8%)	0.677	224 (50.8%)	217 (50.8%)	0.998
Annual household income (count [%])	<¥3 million	58 (13.2%)	15,204 (18.3%)	0.008	58 (13.2%)	59 (13.8%)	0.906
	¥3 million to <¥5 million	126 (28.6%)	21,199 (25.6%)		126 (28.6%)	123 (28.7%)
	¥5 million to <¥8 million	123 (27.9%)	20,720 (25.0%)		123 (27.9%)	122 (28.6%)
	≥¥8 million	99 (22.4%)	16,870 (20.3%)		99 (22.4%)	88 (20.5%)
	Decline to answer	35 (7.9%)	8,951 (10.8%)		35 (7.9%)	36 (8.4%)
Type of insurance (count [%])	National Health Insurance	199 (45.1%)	37,078 (44.7%)	0.050	199 (45.1%)	190 (44.4%)	0.987
	Social Insurance	222 (50.3%)	40,847 (49.2%)		222 (50.3%)	220 (51.5%)
	Late-Stage Elderly Insurance	7 (1.6%)	911 (1.1%)		7 (1.6%)	7 (1.5%)
	Other	9 (2.0%)	1,324 (1.6%)		9 (2.0%)	8 (1.8%)
	None of the above	4 (0.9%)	2,784 (3.4%)		4 (0.9%)	3 (0.8%)
BMI category (count [%])	Underweight	59 (13.4%)	9,122 (11.0%)	0.176	59 (13.4%)	55 (12.8%)	0.988
	Acceptable risk	228 (51.7%)	42,108 (50.8%)		228 (51.7%)	219 (51.2%)
	Increased risk	115 (26.1%)	22,339 (26.9%)		115 (26.1%)	114 (26.7%)
	High risk	28 (6.3%)	5,709 (6.9%)		28 (6.3%)	29 (6.7%)
	Decline to provide weight	11 (2.5%)	3,666 (4.4%)		11 (2.5%)	11 (2.7%)
Alcohol use (count [%])	Drink alcohol	298 (67.6%)	57,672 (69.5%)	0.373	298 (67.6%)	288 (67.4%)	0.950
Smoking behavior (count [%])	Never smoked	213 (48.3%)	46,436 (56.0%)	0.004	213 (48.3%)	213 (49.8%)	0.783
	Former smoker	117 (26.5%)	19,676 (23.7%)		117 (26.5%)	113 (26.4%)
	Current smoker	111 (25.2%)	16,832 (20.3%)		111 (25.2%)	102 (23.9%)
Exercise behavior (count [%])	Do not exercise	237 (53.7%)	47,919 (57.8%)	0.087	237 (53.7%)	238 (55.7%)	0.415
CCI (mean±SD/SE)		1.29±4.83	0.14±0.46	<0.001	1.29±0.23	0.51±0.04	<0.001

Notes: SDs and SEs are provided for the unweighted and weighted comparisons, respectively.

Abbreviations: BMI, body mass index; CCI, Charlson Comorbidity Index; IBD, inflammatory bowel disease; SE, standard error.

Table 2 Effect of IBD on HRQoL, impairment to work and non-work activities, and HRU – bivariate analysis

Parameters	Outcomes stratified – unadjusted			Outcomes stratified – adjusted
	IBD n=441	Control n=82,944	P-value	IBD n=441	Control n=428	P-value
MCS (mean ± SD/SE)	44.7±11.6	47.8±9.7	<0.001	44.7±0.6	47.4±0.1	<0.001
PCS (mean ± SD/SE)	49.5±7.3	53.4±6.2	<0.001	49.5±0.4	52.5±0.1	<0.001
Health state utility score (mean ± SD/SE)	0.71±0.14	0.76±0.12	<0.001	0.71±0.01	0.75±0.002	<0.001
Absenteeism (mean ± SD/SE [count])a	9.3±22.1 (271)	3.0±12.8 (46,781)	<0.001	9.3±1.3 (271)	3.6±0.2 (260)	<0.001
Presenteeism (mean ± SD/SE [count])a	29.6±28.7 (273)	20.1±24.2 (47,896)	<0.001	29.6±1.7 (273)	21.5±0.5 (266)	<0.001
Overall work impairment (mean ± SD/SE [count])a	33.4±32.0 (271)	21.7±26.1 (46,781)	<0.001	33.4±1.9 (271)	23.3±0.6 (260)	<0.001
Activity impairment (mean ± SD/SE)	30.0±28.8	22.0±25.3	<0.001	30.0±1.4	23.6±0.3	<0.001
Health care provider visits in the past 6 months (mean ± SD/SE)	11.8±25.9	4.5±7.9	<0.001	11.8±1.2	5.7±0.2	<0.001
Hospitalizations in the past 6 months (mean ± SD/SE)	2.9±10.9	0.5±4.3	<0.001	2.9±0.5	0.8±0.1	<0.001
ER visits in the past 6 months (mean ± SD/SE)	0.9±5.3	0.1±1.0	<0.001	0.9±0.3	0.2±0.1	<0.001

Notes:

a Number of patients. SDs and SEs are provided for the unweighted and weighted comparisons, respectively.

Abbreviations: ER, emergency room; HRQoL, health-related quality of life; HRU, health care resource utilization; IBD, inflammatory bowel disease; MCS, mental component summary; PCS, physical component summary; SE, standard error.

Table 3 Effect of IBD on direct and indirect costs – bivariate analysis

Parameters	Outcomes stratified – unadjusted			Outcomes stratified – adjusted
	IBD n=441	Control n=82,944	P-value	IBD n=441	Control n=428	P-value
APP indirect costs (¥) (mean ± SD/SE [count])a	1,580,075±1,620,518 (271)	980,639±123,9132 (46,781)	<0.001	1,580,075±98,440 (271)	1,081,572±15,961 (260)	<0.001
APP direct costs (¥) (mean ± SD/SE)	3,558,388±12,538,399	637,329±4,834,130	<0.001	3,558,388±597,067	1,033,987±58,736	<0.001
APP physician costs (¥) (mean ± SD/SE)	194,058±427,337	74,512±129,903	<0.001	194,058±20,349	93,452±3,748	<0.001
APP hospital costs (¥) (mean ± SD/SE)	178,924±662,460	30,080±259,647	<0.001	178,924±31,546	50,133±3,091	<0.001
APP ER costs (¥) (mean ± SD/SE)	54,228±327,688	6,334±63,562	<0.001	54,228±15,604	13,068±3,339	<0.001

Notes:

a Number of patients. SDs and SEs are provided for the unweighted and weighted comparisons, respectively.

Abbreviations: APP, annual per-patient; ER, emergency room; IBD, inflammatory bowel disease; SE, standard error.

Table 4 Association of IBD with HRQoL, impairment to work and non-work activities, and HRU – multivariable analysis

Dependent variables	Adjusted mean ± SE (95% CI)		P-value
	IBD	Control
MCS	45.1±0.1 (45.0–45.2)	47.3±0.1 (47.2–47.4)	<0.001
PCS	50.2±0.03 (50.1–50.3)	52.8±0.03 (52.7–52.9)	<0.001
Health state utility score	0.71±0.00 (0.71–0.72)	0.75±0.00 (0.75–0.75)	<0.001
Absenteeism	8.1±0.2 (7.7–8.6)	3.1±0.1 (3.0–3.23)	<0.001
Presenteeism	28.1±0.3 (27.6–28.7)	20.7±0.1 (20.4–21.0)	<0.001
Overall work impairment	32.0±0.3 (31.4–32.6)	22.4±0.1 (22.1–22.6)	<0.001
Activity impairment	28.4±0.2 (28.0–28.9)	22.8±0.1 (22.6–22.9)	<0.001
ER visits in the past 6 months	0.3±0.03 (0.24–0.37)	0.1±0.00 (0.11–0.12)	<0.001
Hospitalizations in the past 6 months	2.1±0.1 (2.0–2.3)	0.6±0.02 (0.6–0.7)	<0.001
Health care provider visits in the past 6 months	7.4±0.26 (7.11–7.74)	4.5±0.03 (4.46–4.59)	<0.001

Abbreviations: ER, emergency room; HRU, health care resource utilization; IBD, inflammatory bowel disease; MCS, mental component summary; PCS, physical component summary; SE, standard error.

Table 5 Effect of IBD on direct and indirect costs – multivariable analysis

Dependent variables	Adjusted mean ± SE (95% CI)		P-value
	IBD	Control
APP indirect costs (¥)	1,546,610±11,669 (1,523,907–1,569,650)	1,067,331±8,080 (1,051,612–1,083,284)	<0.001
APP direct costs (¥)	2,563,141±69,856 (2,429,819–2,703,778)	808,467±24,132 (762,526–857,176)	<0.001
APP hospital costs (¥)	130,044±6,128 (118,572–142,626)	37,531±1,440 (34,811–40,463)	<0.001
APP ER costs (¥)	18,646±1,632 (15,708–22,135)	7,095±199 (6,716–7,496)	<0.001
APP physician costs (¥)	122,521±2,183 (118,316–126,874)	74,720±440 (73,863–75,588)	<0.001

Abbreviations: APP, annual per-patient; ER, emergency room; IBD, inflammatory bowel disease; SE, standard error.

Table 6 Comparisons for sociodemographics and health characteristics for the respondents diagnosed with UC or CD, while excluding those respondents diagnosed with both

Parameters		Diagnosis
		Diagnosed with CD n=69	Diagnosed with UC n=363	P-value
Age (mean ± SD)	Years	41.7±14.0	49.8±14.5	<0.001
Sex (count [%])	Male	48 (69.6%)	217 (59.8%)	0.126
Currently employed (count [%])	Yes	43 (62.3%)	243 (66.9%)	0.457
University education (count [%])	Less than university education	39 (56.5%)	184 (50.7%)	0.374
Annual household income (count [%])	<¥3 million	10 (14.5%)	48 (13.2%)	0.329
	¥3 million to <¥5 million	13 (18.8%)	113 (31.1%)
	¥5 million to <¥8 million	21 (30.4%)	101 (27.8%)
	≥¥8 million	18 (26.1%)	73 (20.1%)
	Decline to answer	7 (10.1%)	28 (7.7%)
Type of insurance (count [%])	National Health Insurance	33 (47.8%)	161 (44.4%)	0.704
	Social Insurance	34 (49.3%)	186 (51.2%)
	Late-Stage Elderly Insurance	0 (0%)	7 (1.9%)
	Other	2 (2.9%)	7 (1.9%)
	None of the above	0 (0%)	2 (0.6%)
BMI category (count [%])	Underweight	13 (18.8%)	44 (12.1%)	0.320
	Acceptable risk	37 (53.6%)	185 (51.0%)
	Increased risk	12 (17.4%)	102 (28.1%)
	High risk	5 (7.2%)	23 (6.3%)
	Decline to provide weight	2 (2.9%)	9 (2.5%)
Alcohol use (count [%])	Drink alcohol	39 (56.5%)	250 (68.9%)	0.046
Smoking behavior (count [%])	Never smoked	32 (46.4%)	179 (49.3%)	0.763
	Former smoker	18 (26.1%)	99 (27.3%)
	Current smoker	19 (27.5%)	85 (23.4%)
Exercise behavior (count [%])	Do not exercise	41 (59.4%)	194 (53.4%)	0.361
CCI (mean ± SD)		1.10±3.28	0.58±1.97	0.077

Abbreviations: BMI, body mass index; CCI, Charlson Comorbidity Index; CD, Crohn’s disease; UC, ulcerative colitis.

Table 7 Patient-reported outcomes stratified by UC/CD diagnosis

Parameters	Outcomes stratified – unadjusted
	Diagnosed with CD, n=69	Diagnosed with UC, n=363	P-value
MCS (mean ± SD)	41.4±10.9	45.7±11.4	0.004
PCS (mean ± SD)	47.6±7.7	50.2±6.9	0.005
Health state utility score (mean ± SD)	0.67±0.15	0.72±0.13	0.002
Absenteeism (mean ± SD [count])a	14.7±28.0 (40)	8.3±20.9 (226)	0.094
Presenteeism (mean ± SD [count])a	31.0±30.5 (41)	28.8±27.8 (226)	0.645
Overall work impairment (mean ± SD [count])a	36.9±33.3 (40)	32.4±31.4 (226)	0.410
Activity impairment (mean ± SD)	32.9±31.0	28.8±27.7	0.275
Health care provider visits in the past 6 months (mean ± SD)	11.1±15.3	9.5±16.7	0.446
Hospitalizations in the past 6 months (mean ± SD)	6.5±16.4	1.7±7.6	<0.001
ER visits in the past 6 months (mean ± SD)	0.8±2.3	0.4±1.7	0.053

Note:

a Number of patients.

Abbreviations: CD, Crohn’s disease; ER, emergency room; MCS, mental component summary; PCS, physical component summary; UC, ulcerative colitis.

Table 8 Direct and indirect costs stratified by UC/CD diagnosis

Parameters	Outcomes stratified – unadjusted
	Diagnosed with CD, n=69	Diagnosed with UC, n=363	P-value
APP indirect costs (¥) (mean ± SD [count])a	1,645,068±1,609,221 (40)	1,562,054±1,623,572 (226)	0.766
APP direct costs (¥) (mean ± SD)	7,533,257±18,638,315	2,135,095±8,642,032	<0.001
APP physician costs (¥) (mean ± SD)	184,092±251,934	156,762±276,329	0.446
APP hospital costs (¥) (mean ± SD)	394,422±1,000,568	105,666±464,105	<0.001
APP ER costs (¥) (mean ± SD)	52,350±143,145	23,504±106,434	0.053

Note:

a Number of patients.

Abbreviations: APP, annual per-patient; CD, Crohn’s disease; ER, emergency room; UC, ulcerative colitis.