The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs

Abstract Healthcare utilization among people living with inflammatory bowel disease (IBD) in Canada has shifted from inpatient management to outpatient management; fewer people with IBD are admitted to hospitals or undergo surgery, but outpatient visits have become more frequent. Although the frequency of emergency department (ED) visits among adults and seniors with IBD decreased, the frequency of ED visits among children with IBD increased. Additionally, there is variation in the utilization of IBD health services within and between provinces and across ethnocultural and sociodemographic groups. For example, First Nations individuals with IBD are more likely to be hospitalized than the general IBD population. South Asian children with Crohn’s disease are hospitalized more often than their Caucasian peers at diagnosis, but not during follow-up. Immigrants to Canada who develop IBD have higher health services utilization, but a lower risk of surgery compared to individuals born in Canada. The total direct healthcare costs of IBD, including the cost of hospitalizations, ED visits, outpatient visits, endoscopy, cross-sectional imaging, and medications are rising rapidly. The direct health system and medication costs of IBD in Canada are estimated to be $3.33 billion in 2023, potentially ranging from $2.19 billion to $4.47 billion. This is an increase from an estimated $1.28 billion in 2018, likely due to sharp increases in the use of biologic therapy over the past two decades. In 2017, 50% of total direct healthcare costs can be attributed to biologic therapies; the proportion of total direct healthcare costs attributed to biologic therapies today is likely even greater. Lay Summary It is expensive to care for people with inflammatory bowel disease (IBD). IBD may make a person need to go to the hospital, take medicine, or have surgery. The cost of caring for people with IBD has been growing over the past 20 years. This is partly because of more expensive medicines called biologics. Biologics started being used in Canada in 2001 and are now very common. Now, biologics make up more than half the total cost of treating IBD. In 2018, we believe that the total cost of hospitals, surgeries and medicines to treat IBD was $1.28 billion. Today, in 2023, we estimate that the total cost to treat IBD is roughly $3.33 billion. In this article, we have gathered data from published studies that let us evaluate the current cost of caring for IBD in Canada. We show how diffe