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The financial cost of Crohn's disease.

Current medical treatments of Crohn's disease are expensive. In a study conducted in 1990 in the USA, it was estimated that the average expenditure per year was $6,561 on every Crohn's disease patient in that country. Eight years of inflation must place todays expenditure figure as higher, since medical treatments have not changed since that time. The total expenditure in the USA in 1990 was between $1,000,000,000 and $1,200,000,000. Again, this must have increased, not only due to the increased cost of treatment, but also to the increased number of sufferers of the disease.

Expenditure on Crohn's disease covers:-

  • Surgery. Up to seventy five per cent of Crohn's disease patients will undergo surgery at some stage of their lives. See the reference "Management of inflammatory bowel disease: 30 years of observation".
  • Drug therapy. Drug therapies are long term, perhaps for months or years. Although steroids are cheap drugs, some drugs used for Crohn's disease are expensive. A months supply of Mercaptopurine, an immunosuppressive drug, can cost between 50 and 200 dollars. A months supply of Cholestyramine, a supplement used to control metabolisation of fat after surgery, can cost one hundred dollars.
  • Ostomy bags. Some Crohn's disease patients are left with an ostomy after surgery. The cost of ostomy maintenance, including bags, sterile creams and preparations, can add up to hundreds of dollars a month.
  • Parenteral nutrition. This form of therapy is sometimes necessary in patients that have had large segments of intestines surgically removed, or in children. It involves direct placement of specially prepared food directly into the stomach, by use of a tube. The patient is fed this way over a period of hours, either as an in-patient or while asleep at home. The cost of the specially prepared nutrients can add up to thousands of dollars a month.
  • Experimental treatments. More recently developed treatments, such as Avakine, are based on advanced genetic technologies and are extremely expensive. Avakine is a monoclonal antibody which is produced from genetically altered mice. The cost of a single infusion of Avakine is in the region of $1,500.

Note that the cost figure of $6,561 per patient is for medical cost only, and does not include social welfare support for patients that are temporarily or permanently incapacitated. And of course, monetary figures cannot reflect the extent of human suffering that happens everyday as a result of Crohn's disease.

Since the figure of $6,561 is in 1990 US dollars, it is reasonable to apply an inflation calculation to bring that figure up to date. Assuming an average annual inflation rate of 3% per annum, an equivalent 1998 figure would be $8,311 per patient per year.

It is difficult to know how many people in the world suffer from Crohn's disease. The highest reported prevalence to date is in northeastern Scotland, where almost 0.15 per cent of the population have the disease. Based on the latest epidemiology research from the United States, the most likely conclusion is that there are 400,000 people in the United States who suffer from Crohn's disease. The population of the United States is 270 million people. This means that the current prevalence of Crohn's disease in the United States is 148 cases per 100,000 people.

Most of developed world has a similar prevalence of Crohn's disease to the United States. This includes Canada, The European Union, Eastern Europe, Australia, New Zealand, South Africa, etc.

With the combined populations of these regions at nearly 1,000,000,000 people, this gives an (estimated) total number of Crohn's sufferers in 1998 of 1,480,000 people. At a cost of US$8,311 per patient, an extremely rough estimate of total cost every year is US$12,300,280,000, or over twelve billion dollars per year.

The US researchers estimate that the prevalence of Crohn's disease in that country will stabilize at 250 cases per 100,000 people, and that in the year 2005, there will be at least 600,000 cases of Crohn's disease in the United States.. Extrapolating this figure to the rest of the world, we can estimate that there will be 2,220,000 people with Crohn's disease in the world by the year 2005. Assuming no change in medical treatment by that time, and an inflation rate of 3%, medical cost per year for Crohn's disease will be US$10,221 per year. Therefore total medical cost for treatment of Crohn's disease could be as high as US$22 billion per year by the year 2005, worldwide.

Obviously, some very loose assumptions have been made in these calculations, to simplify them. However, although there are some fairly large margins for error in these calculations, the figures indicate that Crohn's disease is an enormous global problem. It is certain that there are over 1 million people in the world in 1998 who suffer from Crohn's disease, and that Crohn's disease is costing many billions of dollars every year.

Might an investment of some millions of dollars into research on Mycobacterium paratuberculosis yield savings of billions of dollars? Not to invest in research into Mycobacterium paratuberculosis is sheer insanity.

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The Epidemiology of Crohn's Disease