The Crohn’s and Colitis Foundation of Canada just released a report on the Impact of Inflammatory Disease in Canada. Pages 47-49 in particular, which deal with the costs of medications and their burden for patients with Crohn’s, and pages 53-57 and 61-64, about the impact of Crohn’s and colitis on employment, are germane to this blog.
On one hand, I’m happy that there are some new statistics available, and that they show that surgeries for Crohn’s have been declining with the increased use of biologic medications. On the other hand, they’re rather depressing (if not surprising), in that they confirm that there is an ongoing conundrum of what to do about the skyrocketing cost of biologics and that Crohn’s has a significantly negative impact on employment and quality of life.
Some of the summary and recommendations, on pages 83-87, are worth repeating here, notably:
Equal and timely access to clinically appropriate medications is vital to persons living with IBD. In Canada, drug plan formulary decisions are based on the pharmoecononic evaluations conducted by the Common Drug Review and provincial drug plans. However, the current system leads to untimely and inequitable access to medications across the country that is not based on patients’ needs but a reflection where people live and their financial means.
- Recent treatment options can help prevent hospitalizations and improve health outcomes and quality of life for people with IBD. Unfortunately, many of these therapies are expensive and may not be available, or have restricted access, through provincial drug plans.
- The cost of pharmaceuticals can be prohibitive, and there is significant variability in access to and coverage for vital medications between provincial formularies, forcing some patients into surgeries (with their associated impacts) that might otherwise be avoidable.
- Biological therapies, in particular, pose significant access issues due to their high cost. Access and coverage may depend on the insurance status of the patient – those with private health insurance may be able to obtain a limited supply – while those without, depend on variable provincial drug plans.
Crohn’s disease and ulcerative colitis can have long-term impacts on employment prospects, particularly due to the age of onset early in life. These demographic factors also mean that the person may not have built up adequate leave entitlements and pension contributions, in comparison to diseases with later onset where more leave is able to be taken, which can then act to impede dismissal.
- There is poor employment protection against redundancy and demotions due to time required away from work, and reports of job loss due to illness are common.
- The effect of symptoms – fatigue, diarrhea, pain and the secondary effects of medications – are not well understood or accommodated in the workplace.
- There can be poor information and support for employers and employees in relation to IBD.