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Effect of Aging on Healthcare Costs of Inflammatory Bowel Disease: A Glimpse into the Future

van der Have, Mike MD1; Mangen, Marie-Josée J. PhD2; van der Valk, Mirthe E. MD1; Smeets, Hugo M. PhD2,3; van Bodegraven, Ad PhD4; Dijkstra, Gerard PhD5; Fidder, Herma H. PhD1; de Jong, Dirk J. PhD6; Pierik, Marieke PhD7; Ponsioen, Cyriel Y. PhD8; van der Meulen-de Jong, Andrea E. PhD9; van der Woude, C. Janneke PhD10; van de Meeberg, Paul C. PhD11; Romberg-Camps, Mariëlle J. L. PhD12; Clemens, Cees H. M. PhD13; Jansen, Jeroen M. MD14; Mahmmod, Nofel MD15; Bolwerk, Clemens J. M. MD16; Vermeijden, J. Reinoud MD17; Siersema, Peter D. PhD1; Leenders, Max MSc1; Oldenburg, Bas PhD1

doi: 10.1097/01.MIB.0000442677.55051.03
Original Clinical Articles

Background: Population aging is expected to result in a substantial additional burden on healthcare resources in the near future. We aimed to assess the current and future impact of aging on direct healthcare costs (DHC) attributed to inflammatory bowel disease (IBD).

Methods: Patients with IBD from a Dutch multicenter cohort filled out 3-monthly questionnaires for 2 years. Elderly (≥60 yr) and younger patients (18–60 yr) IBD were analyzed for differences in 3-monthly DHC, productivity losses, and out-of-pocket costs. Prevalence rates were obtained from a health insurance database. Estimates of annual DHC and prevalence rates were applied to the total Dutch adult population in 2011 and then projected to 2040, using predicted changes in population demography, prices, and volume.

Results: IBD-attributable DHC were lower in elderly than in younger patients with IBD with respect to 3-monthly DHC (€359 versus €978, P < 0.01), productivity losses (€108 versus €456, P < 0.01), and out-of-pocket costs (€40 versus €57, P < 0.01). Between 2011 and 2040, the percentage of elderly IBD patients in the Netherlands has been projected to rise from 24% to 35%. Between 2011 and 2040, DHC of the total IBD population in the Netherlands are projected to increase from €161 to €661 million. Population aging accounted for 1% of this increase, next to rising prices (29%), and volume growth (70%).

Conclusions: Population aging has a negligible effect on IBD-attributable DHC of the IBD population in the near future, because the average costs incurred by elderly patients with IBD are considerably lower than those incurred by younger patients with IBD.

Article first published online 10 February 2014Supplemental Digital Content is Available in the Text.

1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands

2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands;

3Agis Health Insurance, Amersfoort, the Netherlands;

4Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands;

5Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands;

6Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands;

7Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands;

8Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands;

9Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands;

10Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands;

11Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, the Netherlands;

12Department of Gastroenterology and Hepatology, Orbis Medical Center, Sittard, the Netherlands;

13Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, the Netherlands;

14Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands;

15Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands;

16Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, the Netherlands; and

17Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands.

Reprints: Mike van der Have, MD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, Utrecht 3500 GA, the Netherlands (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. A. van Bodegraven has acted as a consultant for Abbvie and MSD and received payments for lectures from Abbvie and Ferring. H. H. Fidder has acted as a consultant for Abbvie. D. J. de Jong has acted as a consultant for Synthon Netherlands and received payments for lectures from Abbvie, Ferring, and MSD. C. Y. Ponsioen has acted as a consultant for Abbvie and received payments for lectures from Ferring and MSD. A. E. van der Meulen-de Jong has acted as consultant for Abbvie. M. Pierik has acted as a consultant MSD and received payments for lectures from MSD, Falk Pharma, Abbvie and Ferring. C. J. van der Woude has acted as a consultant for Abbvie, Ferring, Shire, and MSD and received payment for lectures from Abbvie, Falk Pharma and MSD. B. Oldenburg has received payments for lectures from Ferring and acted as a consultant for Abbvie and MSD.

Supported by an unrestricted grant from Abbvie.

Received November 26, 2013

Accepted December 19, 2013

© Crohn's & Colitis Foundation of America, Inc.
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