# Comparison of cost of care in patients with flares vs. remission in ulcerative colitis: A perspective from a developing country

## TL;DR

This study compares the financial burden of managing ulcerative colitis during flare-ups versus remission in a developing country.

## Contribution

The study provides a detailed cost analysis of ulcerative colitis care during remission and acute flares in a developing country context.

## Key findings

- The average monthly cost of care during remission was 4,112/- INR, with medications being the main expense.
- Acute flare episodes cost significantly more, averaging 44,634/- INR per episode, with productivity loss being a major indirect cost.
- Surgically managed flares cost 155,967/- INR on average, significantly higher than medically managed flares.

## Abstract

Ulcerative colitis (UC) is a chronic relapsing-remitting disease that results in not only physical, mental and social, but also a significant financial burden to patients and their caregivers. The present study aimed to analyse the monthly cost of care for patients with UC in remission during their regular follow-up and compare this to the expenses born during an episode of acute exacerbation in order to estimate the costs of such episodes of acute severe UC (ASUC). Patients in remission defined using the simple clinical colitis activity index (SCCAI) of <3 were recruited from the outpatient department. Patients with flares were those requiring admission for ASUC. Demographic and clinical data were recorded for each patient. A prevalence-based, micro-costing, human capital approach was used to estimate the direct and indirect monthly per capita mean cost-of-illness. The present study enrolled 25 patients with UC who were in remission (SCCAI of <3) and 51 patients with UC who presented with flares and required hospitalisation for ASUC between January, 2022 to June, 2024. The average monthly cost of care for patients with UC in remission in a tertiary government setup was calculated to be 4,112/- INR. The direct medical cost was 3,676/- INR and the direct non-medical cost was 435/- INR. The cost of management of an episode of ASUC was 44,634/- INR per individual per episode. The direct medical cost was 20,038/- INR, the direct non-medical cost was 4,087/- INR and the indirect cost was 20,509/- INR. The cost of the flares managed surgically was 155,967±100,554/- INR, which was significantly higher than that of flares managed medically (26,922±22,751/- INR; P<0.001). The cost of illness during episodes of acute flares contribute disproportionately to a high financial burden in care of patients with UC. Direct medical costs due to the cost of medications is a major contributor to the cost of care for patients with UC in remission whereas during a period of flares, the indirect cost due to productivity loss is responsible for the majority of the financial burden.