Costs of medications used to treat inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD), mainly Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases causing a lifelong burden and often need sustained treatment throughout a patient's life. Both the incidence and prevalence of IBD has increased in the last decade. Evidence showing the drug costs to IBD patients in Finland is limited. No earlier study has evaluated the drug costs of IBD patients in Finland. Here, we thoroughly assessed these costs. METHODS: A structured questionnaire, hospital records and national registers were combined to comprehensively assess the actual costs of drug purchases made by IBD patients. The study sample comprised 561 patients. RESULTS: Total annual mean drug costs were 1428€ per patient. CD patients had higher annual costs than UC patients at 2369€ and 902€, respectively. CD patients also had higher costs in the immunosuppressant, corticosteroid, and biologic subgroup analyses. In addition, C-reactive protein, serum albumin and fecal calprotectin levels had a correlation with costs if the patient had needed corticosteroids. In addition, women reported having a worse quality of life (QoL) but had lower total costs. CONCLUSIONS: Pharmaceutical drugs are major factors that affect the costs of IBD treatment, and the increased use of biologics has raised these costs.

Effect of inflammatory bowel diseases on household chores.

More than a half of inflammatory bowel disease (IBD) patients experienced a moderate negative effect on their household chores due to their IBD. The negative effect was more common amongst women.

Inflammatory bowel disease: perceived impact on leisure-time activities.

OBJECTIVE: Inflammatory bowel disease, consisting of Crohn's disease and ulcerative colitis, is known to negatively impact an individual's quality of life. Leisure-time activities are an important part of life by creating and strengthening social networks. The aim of this study was to thoroughly evaluate the perceived impact of inflammatory bowel disease on leisure-time activities by quantifying limitations in activities caused by the disease. METHODS: A structured questionnaire, hospital records and national registers were combined to assess limitations caused by the disease in a patient's leisure-time activities. The final study sample was 561 patients. RESULTS: More than half of the patients (52.8%) reported that IBD had caused limitations in their leisure-time activities. Women perceived that their limitations were greater when compared to the reports by men. One-third of the patients (33.3%) reported reducing and 17.6% abandoning at least one leisure-time activity due to their disease. Most often mentioned activities that were reduced and abandoned were physical activities. The IBDQ32 score had a significant correlation with all of the studied outcomes. Laboratory tests results and the patient's age or the level of income did not correlate with limitations in leisure-time activities. CONCLUSIONS: In conclusion, this study showed that patients with inflammatory bowel disease perceived a marked limitation in their leisure-time activities due to their disease.

Cost-minimization modeling of venous thromboembolism diagnostics: performing limited compression ultrasound in primary health care reduces costs compared to referring patients to a hospital.

BACKGROUND: The aim of this retrospective study was to determine whether diagnosing a deep venous thrombosis (DVT) in primary health care using limited compression ultrasound (LCUS) can save resources compared to referring these patients to hospital. According to the current literature, LCUS is as safe as a standard protocol based on a whole-leg ultrasound (US). METHODS: We created a standardized patient for this cost-analysis model based on 76 patients that were referred to hospital for a suspected DVT. Travel distance to the health care centre and hospital was calculated based on the home address. Hospital costs were acquired from the hospital price list and Finnish legislation. Time spent in the hospital was retrieved from hospital statistics. Time spent in the health care centre and travelling were estimated and monetized based on average salary. The cost of participating physicians attending a US training course was estimated based on the national average salary of a general practitioner as well as the course participation fee. A cost-minimization modeling was performed for this standardized patient comparing the total costs, including private and public costs, of standard and LCUS strategies. RESULTS: The total costs per patient of standard and LCUS pathways were 1151.52€ and 301.94€ [difference 849.59€ (95% CI 800.21€-898.97€, p < 0.001)], respectively. The real-life costs of these strategies, considering that some patients are probably referred to hospital every year and including training costs, are 1151.53€ and 508.69€ [difference 642.84€ (95% CI 541.85€-743.82€)], respectively. CONCLUSION: Using LCUS in diagnosing DVT in primary health care instead of referring these patients to the hospital is shown to save a significant amount of public and private resources.

Inflammatory bowel disease-related economic costs due to presenteeism and absenteeism.

BACKGROUND: Inflammatory bowel disease (IBD), consisting of Crohn's disease and ulcerative colitis, can be a lifelong burden generating high costs to an economic system. Data regarding the cost of workplace presenteeism and absenteeism in workers with IBD are limited. Our objective was to assess these costs in employed adults. METHODS: A structured questionnaire, hospital records and national registers were combined to assess the economic costs involved with workplace presenteeism and absenteeism in employed patients. Our final sample comprised 320 IBD patients. The costs were calculated as productivity-loss costs by using a Human Capital Approach. RESULTS: Due to IBD, the mean annual economic costs of workplace presenteeism were €643.90/patient, and mean annual absenteeism costs were €740.90/patient. Women had higher costs (€955/patient/year) from absenteeism compared to men (€531/patient/year) especially when working blue-collar jobs. These findings were also evident in presenteeism. CD and UC patients had similar total costs due to presenteeism and absenteeism. The use of biologics did not have a major impact on these costs. CONCLUSION: IBD patients had moderate economic costs from workplace presenteeism and absenteeism. Interestingly, women, working blue-collar jobs, had higher costs than men.

The Delay and Costs of Diagnosing Systemic Vasculitis in a Tertiary-Level Clinic.

INTRODUCTION: The diagnosis of systemic vasculitis is a challenge because of the heterogeneity of clinical manifestations. The aim of this study is to analyze the diagnostic delay in systemic vasculitis, the total costs during the first year of care, and how the diagnostic delay affects the costs in a tertiary health care facility. METHODS: Patients with a new diagnosis of systemic vasculitis between 2010 and 2018 were identified from hospital records. The diagnostic delay and health care costs were evaluated during the diagnostic period and within 12 months after the first contact with tertiary health care. Vasculitis-related costs were recorded as true costs charged. A total of 317 patients fulfilled the study criteria. The diagnoses were grouped into three clinically relevant groups: IgA vasculitis and other small-vessel vasculitis (n = 64), ANCA-associated vasculitis (AAV) (n = 112), and large-vessel vasculitis (LVV) (n = 141). RESULTS: The diagnostic delay from the first referral to tertiary-level clinic was shortest in the LVV group and longest in the AAV group. Total costs during the diagnostic period were the highest in the AAV group (median = €6754 [IQR €8812]) and lowest in the LVV group (median = €3123 [IQR €4517]), p < 0.001. There was a significant positive correlation between the diagnostic delay and total costs during the diagnostic period and 12 months (rs = 0.38, p < 0.001 and rs = 0.34, p < 0.001, respectively). In a linear model, the inpatient days and the number of laboratory tests were the strongest predictors (p < 0.001) of a higher treatment cost during the diagnostic period. CONCLUSIONS: There is a substantial diagnostic delay that correlates significantly with the costs in tertiary-level health care when diagnosing systemic vasculitis.

Direct costs of inflammatory bowel diseases in a Finnish tertiary-level clinic.

Background: Inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases associated with a high and continuous economic burden. The introduction of biologics has changed the distribution of costs over the past two decades, and there are no recent studies on direct costs in Finland. This study aimed to estimate the direct healthcare costs of these diseases in a tertiary-level clinic. Methods: The data were collected during a 1-year period of patients with IBD visiting Turku University Hospital. Patients were included if they lived in the hospital district area and were over 18 years old. This comprised an IBD group of 2208 patients, including 794 cases of CD and 1414 cases of UC. A sex-matched and age-matched control group was collected for comparison. Direct costs were collected during a 1-year study period from the hospital records. Results: Total direct costs per patient with IBD in a tertiary-level clinic were €4223 annually. IBD-generated direct costs were estimated to total €3981 per patient annually. Patients with IBD who were given infliximab had €9157 higher direct healthcare costs per patient annually than patients with IBD with no infliximab medication. Direct healthcare costs generated in a tertiary-level gastroenterological clinic averaged €1652 per patient with IBD annually. On average, patients with CD had €1111 higher direct healthcare costs annually than patients with UC. Conclusions: The direct healthcare costs of IBD were significant, almost 17-fold higher compared with a control group. Patients with IBD administered with biologics had significantly higher costs. Patients with CD had higher annual infliximab costs than patients with UC.

Influence of Psoriasis on Household Chores and Time Spent on Skin Care at Home: A Questionnaire Study.

INTRODUCTION: Previous studies have shown that psoriasis has a significant effect on patients' health-related quality of life. The impact of psoriasis on household chores and the need for assistance with such tasks are not well documented. The aim of this study was to estimate the impact of psoriasis on the ability to carry out household chores, the time spent on skin care at home and the assistance that patients with psoriasis require with these activities. METHODS: In a questionnaire study 262 patients with moderate-to-severe psoriasis, visiting a tertiary level dermatological clinic during a 1-year study period, listed household chores which they considered were particularly affected by psoriasis. This was done without a predefined list of chores. Questions on their ability to perform household chores as well as time spent on skin care at home were asked. The need for outside assistance with household chores and help received were also determined. RESULTS: More than half of the patients (57.8%) reported difficulties with household chores because of psoriasis. Psoriasis affected a wide range of everyday household activities, with physically demanding tasks and those involving contact with water mentioned most often. Most of the patients (84.6%) reported that they have increased the time spent on skin care because of psoriasis, on average by 87 min per week. A quarter of patients received assistance in household chores. Women received more assistance than men (p < 0.01). The need for additional assistance was reported by a fifth of patients, women more often than men (p < 0.05). CONCLUSION: When estimating the overall burden of psoriasis, considering only the economic and productivity consequences may underestimate the impact of the disease. The impact on everyday life events such as the ability to perform household chores should also be taken into account. FUNDING: This study was supported by unconditional grants from the research funds of the Hospital District of Southwest Finland. Hospital District of Southwest Finland's research permission K44/10/EVO13043.

How much of the productivity losses among psoriasis patients are due to psoriasis.

BACKGROUND: In previous studies, productivity losses have been measured specifically due to psoriasis or generally due to health problems in psoriasis patients. There is no information on the proportion of health related productivity losses that are due to psoriasis. The aim of this study was to estimate the proportion of productivity losses due to psoriasis and due to other medical problems among employed psoriasis patients. METHODS: Patients visiting a tertiary level dermatological clinic during a one-year period due to psoriasis or psoriasis arthritis, who were employed, were selected to the study. A questionnaire was used to assess productivity losses during the previous month. RESULTS: Psoriasis accounted for 38% of the total lost productivity costs. One fifth of patients had been on sick leave (absenteeism) due to psoriasis and a third of patients worked despite being sick with psoriasis (presenteeism). Men had higher costs of presenteeism, but the costs of absenteeism due to psoriasis were lower for men than for women. CONCLUSIONS: Productivity losses should be assessed disease specifically to avoid overestimations of the role of the disease on indirect costs. Our study shows that about a third of the lost productivity costs are due to psoriasis.

Treatment costs of psoriasis in a tertiary-level clinic.

BACKGROUND: The costs of psoriasis to a tertiary-level clinic vary considerably depending on the country of study and methods used. Hospitalisation and phototherapy have been significant cost components. This study was performed to estimate the distribution and relative magnitude of the costs of psoriasis to a tertiary-level clinic. METHODS: Based on 233 patients, outpatient and phototherapy visits and the days hospitalised were collected from the treatment provider's records. The visit costs represented true costs, used to charge the final payers. Patients were analysed according to their treatment modalities. RESULTS: On average, hospitalised patients (3.4%) had 31-fold higher total costs than non-hospitalised patients (p < 0.0001). The costs of hospitalisations formed 45% of all the treatment costs to the entire study population. Phototherapy accumulated 19% of the overall treatment costs. Patients receiving biological drugs or both phototherapy and traditional systemic therapy had the highest costs of treatment. CONCLUSIONS: The current study indicates that a small percentage of all psoriasis patients generate a large proportion of the overall costs to a tertiary-level hospital. Treatment modality has a significant effect on the costs to a tertiary-level hospital.

Perceived impact of psoriasis on leisure-time activities.

BACKGROUND: Psoriasis has an influence on various aspects of patients' everyday life. When estimating the total burden of the disease, the influence on leisure-time should also be taken into account. OBJECTIVES: To evaluate the perceived impact of psoriasis on leisure-time activities. MATERIAL AND METHODS: The questionnaire study was based on 262 patients with psoriasis. The patients were asked to list their leisure-time activities, any activities they had reduced or given up completely because of psoriasis, the time spent on current leisure-time activities and the time they would have spent in a hypothetical situation if they did not have psoriasis. Using a visual analogue scale (VAS) of 0-100, the patients assessed how well they could currently perform their leisure-time activities and how well in a hypothetical situation without psoriasis. The difference between the VAS scores depicted the level of disadvantage caused by psoriasis. RESULTS: More than half the patients (51.9%) had reduced or completely given up at least one leisure-time activity. The disadvantage score (VAS) of psoriasis was 16.9. Younger age was associated with higher disadvantage (r = 0.154, p<0.05). Sports activities were completely given up by 30.2% and reduced by 23.7%. Social activities and those which could be expected to cause embarrassment were given up by 29.0% and reduced by 21.4% of the patients. CONCLUSION: A majority of patients with psoriasis reduce or give up leisure-time activities because of their condition, so the influence of psoriasis on leisure-time is considerable.

The costs of psoriasis medications.

INTRODUCTION: Psoriasis is a chronic disease, which contributes to the economic burden on health care. The distribution of psoriasis medication costs and the quality of life in these patients has been estimated to be around 20% of total costs. OBJECTIVES: To estimate the economic distribution of medications and the impact of multiple treatment options on a patient's quality of life. MATERIALS AND METHODS: The study was based on 236 Finnish psoriasis patients. The Finnish Social Insurance Institution had databases for all psoriasis related medications purchased. Each purchase, during the 1-year study period (1 October 2009-30 September 2010), was recorded and analyzed. The dermatological quality-of-life index was collected from the medical records. RESULTS: Total medication costs were 1,083 per year per patient. Topical treatments were the most often purchased medication and they comprised 18% of the total medication costs. Ten percent of the patients needed 3 or more medication changes during the 1-year study period. Biologics were used only by 5% of patients, but they produced 67% of total medication costs. Patients needing various treatments had higher medication costs and a poorer quality of life. CONCLUSION: A small number of patients generated a great sum of medication costs partly due to the need to change medications. These patients had the worst quality-of-life index scores. Biologics formed a major cost component.

Influence of psoriasis on work.

BACKGROUND: Previous research indicates that psoriasis has an impact on early retirement, sick leave days and reduced work performance. OBJECTIVES: To evaluate the disadvantages at work caused by psoriasis. MATERIAL AND METHODS: The sample was based on patients visiting the dermatology outpatient clinic in Turku University Hospital. 262 returned a mailed questionnaire. The subjects were asked how many hours they were on a sick leave (absenteeism) and working while sick (presenteeism) due to psoriasis and other health reasons. RESULTS: Of the retired, 17.0% felt they were retired due to psoriasis. Those in the active work force reported on average 4.5 hours absenteeism and 8.3 hours of presenteeism due to psoriasis during the last 4 weeks. Psoriasis caused 27.0% of the total absenteeism and 39.0% of presenteeism. More than a quarter (28.9%) had been forced to modify their work due to psoriasis, most frequently to make the work less irritating for the skin. CONCLUSION: Psoriasis has a negative effect on patients' work in many ways, causing early retirement from work, sick leave days, change of occupation and work modifications.