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patients with ulcerative colitis were hospitalised after 5 years . 27 Healthcare utilisation among patients with IMIDs is also impacted by the number of comorbidities , 2 with an increased number of comorbidities contributing to increased healthcare use ; 7 for instance , co-occurrence of IMIDs with IBD is associated with increased risk of surgery . 17 Type 1 diabetes places a considerable burden on healthcare systems as a leading cause of end-stage renal disease , with approximately 40 % of patients requiring renal replacement therapy . 28

Management of patients with IMIDs typically requires a multidisciplinary approach , which places considerable burden on healthcare systems . 7
Economic burden IMIDs represent a sizeable burden to society due to high healthcare and non-healthcare-related costs . 21 Direct healthcare costs include costly pharmacotherapies , and inpatient care ( e . g ., surgery ). For RA , drug costs comprise up to 87 % of direct costs . 29 However , cost-effective biosimilars of infliximab , etanercept and adalimumab have the potential to reduce the cost burden associated with IMIDs in rheumatology , dermatology and gastroenterology specialties , and increase accessibility to treatment . 30 Indirect costs for individuals include non-prescription medications , transport to and from medical appointments , and household support . 21 Total costs associated with IMIDs are dominated by work disability , with absenteeism , sick days , disability , and early retirement being more common in employees with IMIDs than healthy controls . 21 Lower productivity is observed among employees with IMIDs compared with average employees because of frequent breaks and slower working pace due to pain and reduced mobility . 21 Economic costs are also influenced by the number of comorbidities ; for instance , the increased CVD risk among patients with IMIDs translates to increased healthcare costs . 7
It is difficult to quantify the economic impact of this large group of chronic diseases but analysis of individual IMIDs demonstrates their considerable economic burden . For example , in Europe , the direct healthcare cost of Crohn ’ s disease and ulcerative colitis is approximately € 3500 and € 2000 per patient per year , respectively , with biologics accounting for 70 % and 50 % of these costs , respectively , at 5 years after diagnosis . Surgery within 5 years is required in 10 – 30 % of patients with Crohn ’ s disease and 5 – 10 % of patients with ulcerative colitis . There are also considerable indirect costs of approximately € 1900 per patient per year due to loss of work productivity . 27 Cost estimates for the UK found a total ( direct and indirect ) cost of RA of between £ 3.8 and £ 4.8 billion , while across Europe an annual non-drug cost burden of approximately € 3000 –€ 5000 is reported per patient with RA . 25
Conclusions IMIDs are a group of clinically diverse disorders that affect 5 – 7 % of the Western population and are associated with a dysregulated immune system and shared inflammatory pathways . The incidence and prevalence of IMIDs vary between different ethnicities , and autoimmune disorders are typically more prevalent in women than men . 6 IMIDs place a significant burden on patients ’ lives and can lead to organ damage , physical disability and premature death . 2-4 , 13 These chronic disorders are associated with increased risk of comorbidities , including conditions such as CVD and cancer , and other IMIDs ; this multimorbidity contributes to further reduced quality of life and
It is difficult to quantify the economic impact of this large group of chronic diseases but analysis of individual IMIDs demonstrates their considerable economic burden excess mortality . 2 , 7
In addition to imposing a significant burden on patients , IMIDs are associated with increased healthcare utilisation , 2 , 7 and cause significant socioeconomic impact due to the burden on healthcare systems as well as loss of work productivity for patients . 4
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