Scientific Abstract

Proposal No. IBD-0232
Principal Investigator: Christien Janneke van der Woude, M.D., Ph.D.
Applicant Organization: Erasmus University Medical Center (Rotterdam, The Netherlands)
Project Title: The cost-effectiveness of fatigue management in patients with Crohn’s disease
Period of Award: November 1, 2008 – August 31, 2010

During the last several decades, knowledge has been gained considering the pathogenesis of Crohn’s disease (CD) and newer, more effective drugs available. However, the quality of life of CD patients remains moderate to poor. Fatigue is common problem in CD and is frequently associated with a decreased quality of life. Additionally, fatigue leads to increased work absenteeism and direct medical costs. Although the existence of fatigue in CD patients is common and widely accepted as part of the disease, little is known about the magnitude and severity of this problem. The costs related to IBD consist of direct costs (32%, inpatient care, outpatient care, self-care, medications and tests/procedures) and productivity costs (work absence, decreased earnings, premature death and decreased health related quality of life). The direct costs vary between 6.000 - 40.000 Euros per patient year, and are expected to be higher in IBD patients with fatigue than in those without. Fatigue may result in a defensive and ineffective use of medical attention and resources and therefore to more frequent visits, more tests and often variable treatment. If an effective treatment would be offered to deal with the fatigue, this would redirect the medical attention seeking behaviour of the patient, and could result in a more cost effective way of treating these patients.

Problem Solving Therapy (PST) is often used in psychological intervention based on a general model of coping with stress. This model assumes that a chronic disease causes a number of stressful problems in daily living. These stressful problems increase the chances that the patients are anxious and depressed. The treatment goal of PST is to increase the capabilities of the patients to deal with the stressful problems in daily living, caused by CD. In this way the anxiety and depression should be reduced. The method has been empirically validated and shown to be successful in other patient groups with chronic diseases. For the purposes of this study the PST will be modified to focus on fatigue management (PSTF). In this study we will investigate the cost-effectiveness of these fatigue courses in CD patients. The economic evaluation will be undertaken from a societal perspective including the costs due to resource utilisation within the healthcare (direct medical costs), patients’ costs and costs due to productivity costs, e.g., costs due to absence from work and reduced efficiency. The effect of these courses on fatigue and quality of life will be measured by the multidimensional fatigue index 20 (MFI-20) and quality of life by the Inflammatory bowel disease questionnaire (IBDQ)

If this intervention proves to be cost-effective, this fatigue coping strategy can be implemented in daily IBD care.