Biotechnology Healthcare - November/December 2008 - (Page 12) AT A GLANCE Digestive Diseases: Epidemiology, Economics, and the Pipeline Lola Butcher, Contributing Editor U p to 70 million Americans suffer from digestive diseases — a wide range of conditions that includes inflammatory bowel disease (IBD), chronic hepatitis, short bowel syndrome, and some low-incidence cancers. Together, these disorders account for 9 percent of all hospital admissions. Biologic therapies appear to hold great promise for Crohn’s disease and ulcerative colitis — two chronic IBD conditions with no cure. IBD is 1 of the 5 most prevalent gastrointestinal conditions in the United States, accounting for more than $1.7 billion in health care costs each year. EXTENT OF DISEASE Incidence and prevalence The incidence and prevalence of IBD vary greatly by geography and over time. In general, Western nations exhibit greater incidence, suggesting an environmental or lifestyle influence. Incidence rates increased after 1940, leveling off 30 years later. Crohn’s disease 8.4 174 +31% Ulcerative colitis 12.4 269 –7% Et cetera: Approximately 1.1 million people with IBD lived in the United States in 2000. Ulcerative colitis is slightly more common in males, while Crohn’s disease is more frequently diagnosed in women. IBD epidemiology Incidence per 100,000 population Prevalence per 100,000 population Change in prevalence between 1991 and 2001 Sources: CDC 2007 (incidence data) and Loftus 2007 (prevalence data) ECONOMIC BURDEN Direct and indirect costs The mean annual direct medical costs for Crohn’s patients was $12,417, ranging from $6,277 in patients with mildest levels of disease to $37,135 for those with severe disease that required hospitalization — according a mid-1990s study of commercially insured patients, published by Feagan in the American Journal of Gastroenterology in 2000. The emergence of biologic therapies since then is changing the care patterns and forcing a re-evaluation of the total cost-of-treatment model. Economic factors associated with IBD patients Estimated number per year Hospitalizationsa 162,000 Physician visitsb 5,900,000 Disability claimsc 161,000 Sources: aKozak 2005, bBurt 2004, cCollins 1997 Reductions in health care services for Crohn’s patients treated with a biologic I All Crohn’s patients (N=79) (%) Hospitalizations All surgeries I Fistula patients (n=37) (%) Endoscopies All outpatient visits GI outpatient visits All radioSurgical outpatient logic exam- Non-plain inations films visits Gastrointestinal surgeries ED visits 11 38 59 66 18 43 59 19 16 27 20 12 26 31 70 40 13 66 64 61 Source: Rubenstein 2002 Et cetera: Biologics can be highly effective in treating patients with severe disease, but as with all therapies, there are limitations. In general, studies have shown about a 60 percent effectiveness rate — a figure that may improve in time as the field of molecular diagnostics matures. Safety issues among the TNF-α inhibitors — including a small increased risk of tuberculosis and certain cancers — are a concern. Additional data in this report not specifically referenced were obtained from: CCFA (Crohn’s and Colitis Foundation of America). About Crohn’s Disease and Ulcerative Colitis. «http://www.ccfa.org/about/press/ibdfacts». Accessed Oct. 22, 2008. 12 BIOTECHNOLOGY HEALTHCARE · NOVEMBER/DECEMBER 2008 http://www.ccfa.org/about/press/ibdfacts
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