Trends in health-care costs and utilization for inﬂammatory
bowel disease from 2010 to 2014 in Korea: A nationwide
Jung-Wook Kim,* Chang Kyun Lee,* Sang Youl Rhee,
Chi Hyuck Oh,* Jae-Jun Shim
and Hyo Jong Kim*
*Center for Crohn’s and Colitis, Division of Gastroenterology and Hepatology, Department of Internal Medicine,
Division of Endocrinology, Department of
Internal Medicine, and
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
administrative claims, cost and cost analysis,
delivery of health care, health-care costs, health
care, inﬂammatory bowel diseases.
Accepted for publication 10 October 2017.
Dr Chang Kyun Lee, Center for Crohn’s and
Colitis, Division of Gastroenterology and
Hepatology, Department of Internal Medicine,
Kyung Hee University School of Medicine, 26
Kyungheedae-ro, Dongdaemun-gu, Seoul
Declaration of conflict of interest: All authors
declare no conﬂict of interest.
Financial support: The authors of this study
declare that they have not received support
from any source.
Background and Aim: Data regarding health-care costs and utilization for inﬂammatory
bowel disease (IBD) at the population level are limited in Asia. We aimed to investigate
the nationwide prevalence and health-care cost and utilization of IBD in Korea.
Methods: We tracked the IBD-attributable health-care costs and utilization from 2010 to
2014 using the public dataset obtained from Korean National Health Insurance Service
claims. We estimated the nationwide prevalence of IBD using population census data from
Statistics Korea during the same period.
Results: In total, 236 106 IBD patients were analyzed. The estimated IBD prevalence
signiﬁcantly increased from 85.1/100 000 in 2010 to 106/100 000 in 2014. The overall
annual health-care costs for IBD increased from $23.2 million (US dollars) in 2010 to
$49.7 million in 2014 (P < 0.001). During the same period, the health-care cost per capita
also increased from $572.3 to $983.7 (P < 0.001). The outpatient to total cost ratio
increased from 45.5% in 2010 to 66.6% in 2014. Regarding health-care utilization, the
outpatient to total days of service use ratio increased from 73.1% in 2010 to 76.9% in
2014. Of the total days of service used, the proportions of tertiary, general, and
community hospitals increased signiﬁcantly with a concomitant decrease in that of
primary clinics (all P values < 0.001).
Conclusions: This population-based study conﬁrmed the steadily rising rate of prevalence
of IBD in Korea. It also demonstrated that the shifting to outpatient care and advanced care
settings are drivers for the dramatic increase in IBD-related health-care costs in Korea.
Inﬂammatory bowel disease (IBD), which includes Crohn’s dis-
ease (CD) and ulcerative colitis (UC), is a chronic, relapsing,
and incurable disease with low mortality.
As IBD predominantly
affects young adults and carries a lifetime morbidity and low mor-
tality, the disease places a considerable burden on public health
and health-care resources.
Previous studies have demonstrated
that the direct and indirect costs of IBD are considerably high.
In two large population-based studies from North America, the to-
tal IBD-associated health-care costs were estimated as $2.8 billion
in Canada and $6.3 billion in the USA (US) per year.
ally, the cost proﬁle of IBD care has changed over time.
highly effective biological therapies such as anti-tumor necrosis
factor (TNF) agents have been developed, the health-care cost of
IBD has shifted from hospitalization and surgery to anti-TNF
therapy in Europe.
The incidence of IBD in Asia has risen steadily over the past
A nationwide population-based study of Korea
showed that the mean annual incidence of UC was 4.6 per
100 000 and that of CD was 6.2 per 100 000 from 2006 to
Cumulative epidemiologic data from Korea have showed
that the incidence of IBD has increased about 10-fold over two
decades in Korea.
A similar trend was also observed in
The economic burden of IBD would be a paramount
issue in Asia in the near future, given the Western experience.
However, there has been no data regarding the health-care expen-
ditures and utilization for IBD at the population level in the Asian
countries. Cost proﬁle analysis for diagnosis and management of
IBD would help in developing a cost-effective strategy for better
IBD care and reform health-care policies for efﬁcient use of
limited medical resources.
With this background, this population-based study aimed to
examine the trends in IBD-attributable health-care costs and utili-
zation for IBD and estimate the nationwide prevalence of IBD in
Korea from 2010 to 2014.
Data source and patient population. We used public
data from the public data provision system in Korea (http://
opendata.hira.or.kr/ accessed on June 14, 2017). It provides the
private sector with public data such as databases and electronic
Journal of Gastroenterology and Hepatology 33 (2018) 847–854
© 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd