Direct health-care cost utilization in Hong Kong inflammatory bowel disease patients in the initial 2 years following diagnosis

J Gastroenterol Hepatol. 2018 Jan;33(1):141-149. doi: 10.1111/jgh.13817.


Background and aim: There are scanty data on the health-care utilization from Asia where the incidence of inflammatory bowel disease (IBD) is rising rapidly. We aim to determine the direct health-care costs in the first 2 years of diagnosis in an IBD cohort from Hong Kong and the factors associated with high cost outliers.

Methods: This is a retrospective cohort study that included patients newly diagnosed with IBD in a territory-wide IBD registry. Patients' clinical information, hospitalization records, investigations, and IBD treatments were retrieved for up to 2 years following diagnosis of IBD.

Results: Four hundred and thirty-five newly diagnosed IBD patients were included: 198 with Crohn's disease and 237 with ulcerative colitis. Total direct medical expenditure for this cohort 2 years after the IBD diagnosis was $7 072 710: hospitalizations (33%), 5-aminosalicylic acid (23%), imaging and endoscopy (17%), outpatient visits (10%), surgery (8%), and biologics (6%). Mean direct medical costs per patient-year were significantly higher for Crohn's disease ($9918) than ulcerative colitis ($6634; P, 0.001). The total direct health-care cost decreased significantly after transition to the second year (P < 0.01). High cost (> 90th percentile) outliers were associated with surgery (OR 7.1, 95% CI 2.9-17.2) and low hemoglobin on presentation (OR 0.83, 95% CI 0.70-0.96).

Conclusions: Hospitalization and 5-aminosalicylic acid usage accounted for 56% of total direct medical costs in the first 2 years of our newly diagnosed IBD patients. Direct health-care costs were higher in the first year compared with the second year of diagnosis. Surgery and low hemoglobin on presentation were associated with high cost outliers.

Keywords: Crohn's disease; health economics; inflammatory bowel disease; surgery; ulcerative colitis.

MeSH terms

  • Adult
  • Cohort Studies
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Resources / economics*
  • Health Resources / statistics & numerical data*
  • Hong Kong / epidemiology
  • Hospitalization / economics
  • Humans
  • Inflammatory Bowel Diseases / diagnosis
  • Inflammatory Bowel Diseases / economics*
  • Inflammatory Bowel Diseases / epidemiology
  • Inflammatory Bowel Diseases / therapy
  • Male
  • Mesalamine / administration & dosage
  • Mesalamine / economics
  • Middle Aged
  • Retrospective Studies
  • Time Factors
  • Young Adult


  • Mesalamine