Inflammatory bowel diseases: Health care and costs in Sweden in 1994

Background: Inflammatory bowel disease (IBD) has highly variable course and severity. Since comprehensive data on its impact are scarce, we analyzed all IBD care and costs in Sweden (population, 8.8 million). Methods: A cross-sectional observational study, using national registers and surveys on ambulatory care, hospital admissions, medication, sickness leave, and early retirement for IBD in 1994, was carried out. We calculated direct health care costs and indirect 1-year costs caused by morbidity. Results: Ambulatory care was concentrated to specialists in internal medicine at hospitals. One-fourth of the patients accounted for 48% of 1994 hospital admissions. Medication was predominantly aminosalicylates and steroids. Sickness leave episodes were long-on average, 6 weeks. Although uncommon, early retirements lasted 14 years on average. With regard to the underlying prevalence, the use of health care and compensations by Crohn's disease patients was two to four times that of patients with ulcerative colitis. Morbidity took 68% of total costs. Among direct costs, admissions accounted for 58%. Neither complications nor surveillance added much. Conclusion: Ulcerative colitis is twice as common as Crohn's disease. In health care use, these roles are reversed. Since morbidity causes two-thirds of the costs, comprehensive analyses, including indirect costs, are necessary when evaluating new diagnostics and therapies.