Economic burden borne by patients due to diagnostic delays in inflammatory bowel disease: Insights from a survey of newly diagnosed patients.

Abstract

Background and objective: Patients with inflammatory bowel disease (IBD) often experience diagnostic delays owing to the absence of a definitive test. In our country, it is compounded by difficulty in differentiating it from tuberculosis, in certain situations. Hence, we decided to specifically estimate the economic burden that patients with IBD must bear until definitive treatment is initiated.

Methods: This prospective observational study included all consecutive patients with newly diagnosed IBD aged 18 years or older from October 2021 to December 2024. Details regarding symptom onset, investigations and treatments were collected using a structured questionnaire. Details regarding direct medical, direct non-medical and indirect costs were collected.

Results: Ninety-seven patients, mean age 38.7 ± 13.5 years, median symptom duration 15 (7-38.5) months, were included in this study. Crohn's disease (CD) and ulcerative colitis (UC) were present in 55 (56.7%) and 42 (43.3%) patients, respectively. The median (interquartile range [IQR]) per capita monthly household income of the study population in rupees (Rs) was 5000 (3333-12,250). The economic burden due to diagnostic delay was Rs 136,029 (81,863-213,979), which amounted to 5.5 (2.3-9.2) times the monthly household income. The total direct medical, direct non-medical and indirect costs were Rs 69,610 (39,297-110,809), Rs 26,400 (14,238-45,340) and Rs 24,000 (10500-58210), respectively. The diagnostic delay for patients with CD was 3.4 times greater than that for patients with UC (27 [12-60] months vs. 8 [3-20] months; p < 0.001). Patients with CD suffered a greater economic burden than UC patients (Rs 162,750 [116,618-287,630] vs. Rs 96,752 [57,555-145,671]; p < 0.001) and required more visits to the doctor before the diagnosis was made (9 [7-14] vs. 5 [4-8.25]; p < 0.001).

Conclusion: The economic burden of diagnostic delays in patients with IBD is a major problem. Patients with CD experienced longer delays, had more hospital visits and spent more money prior to the initiation of disease-specific therapy than those with UC.