More than 20 million Canadians suffer from digestive disorders every year. Those of you who are affected know how devastating this can be on your personal and professional life. However, because few people speak openly about their digestive symptoms, the magnitude of the problem is underestimated by government, employers and the general public.
- Digestive disorders cost $18 billion (2000) annually in health care costs and lost productivity
- Each year nearly 30,000 Canadian's die of diseases of the digestive system
- Digestive disorders account for 10% of all hospitalizations
- Hospitalization costs for treating severe diarrhea amounted to $71 million in 2005
- Digestive disease steals about 28,000 years from Canadians' lives
- Canada has the highest incidence of gastrointestinal ulcers in the world and Inflammatory Bowel Disease (IBD) in the world
- Over the last decade the prevalence of Canadians with a medically diagnosed bowel disorder has doubled
- Next to lung cancer, digestive cancers kill more Canadians than any other type of cancer. One out of every five new cancer cases in 2009 will involve the digestive tract. Colon cancer has the 2nd highest death rate of all cancers in Canada.
- 10 million Canadians have H. pylori infection with approximately 75% of the people in First Nation communities being infected
- 5 million Canadians experience heartburn at least one time per week. The lost productivity from those who suffer each year amounts to $2.1 billion.
- There are 800,000 Canadians living with Barrett's Esophagus
- In Canada, approximately 400,000 people with Barrett's are asymptomatic
- Diagnosis of Barrett's esophagus requires that suspected patients undergo endoscopy and biopsy. For the current cases of this disease, diagnosis costs more than $400 million.
- Age older than 50 years, male gender, and reflux-symptoms for longer than 1 year are risk factors associated with the development of Barrett's esophagus.
- Daily management of Barrett's esophagus requires chronic acid suppression therapy.
- Central obesity is a known risk factor for developing Barrett's esophagus.
- More than 330,000 Canadians are believed to be affected by celiac disease with only approximately 110,000 diagnosed.
- Each year, families affected by celiac disease spend $150 million to obtain gluten-free foodstuffs; the primary therapeutic option for the disease.
- Gluten-free products are 2.5 times more expensive than regular items making the overall cost of the disease for individuals and their families enormous.
- Access to gluten-free foods prevents families with celiac disease from traveling, dining out, and taking part in social activities thereby decreasing their quality of life while increasing the indirect costs associated with the disease.
- From the first recognizable onset of symptoms, it takes an average time of 1 year to obtain a diagnosis of celiac disease. In some cases, the time to diagnosis may take as long as 12 years.
- Due to under-recognition of celiac disease in pediatric patients, $2.5 million has been spent in the health care system as families consulted 2 or more physicians before receiving a diagnosis for their child.
- Delayed diagnosis of celiac disease increases the individual's risk for the development of serious chronic medical issues which, in turn, will increase their use of the health care system and reduce their ability to contribute to society.
- Rates of celiac disease have nearly doubled in the last 25 years in western countries.
- The risk for developing celiac disease is increased 20 times for those who have a 1st degree relative with the disease.
- Nearly 30% of Canadian children with celiac disease are initially misdiagnosed.
- As 30% of celiac disease patients may develop a malignancy (e.g, non-Hodgkin's lymphoma), adhering to a gluten-free diet is critical for preventive purposes in spite of the personal costs.
- In 2008, $141 million was spent on prescription drugs for the treatment of Crohn's disease.
- The majority of Crohn's disease patients will require hospitalization at some point and more than half will require surgery.
- Worldwide, there are 177 pharmaceutical products indicated for Crohn's disease and 52 pharmaceutical products in clinical trials.
- Most patients develop Crohn's disease during their 20s
- Patients with moderate to severe Crohn's disease have an increased risk of premature death similar to that reported for moderate smokers.
- More than 40% of Crohn's disease patients have subsequently developed lactose intolerance (50 000 Canadians).
- Next to lung cancer, digestive cancers kill more Canadians than any other cancer type.
- 1 out of every 5 new cancer cases in 2009 will involve the digestive tract (32,100 Canadians in 2009)
- Out of every 4 cancer-related deaths in 2009, one death will be attributed to digestive cancers.
- Each year, 15,000 Canadians die from cancers of the digestive tract
- It is estimated that digestive cancers will kill 17,350 Canadians in 2009
- Ontario incurs the largest burden of digestive cancers in Canada.
- Inuit populations have higher than expected rates of esophageal, gall bladder and liver cancers.
- Colon cancer kills more Canadians than any other digestive cancer.
- Colon cancer kills 1 out of every 10 cancer victims.
- Colon cancer has the 2nd highest death rate of all cancers in Canada.
- Acute care inpatient costs for colorectal cancer totaled nearly $215 million in 2004 – 2005.
- Inpatient care for colorectal cancer costs $210 million and is the 15th most expensive condition to treat in Canada.
- Colorectal cancer is ranked as the third most prevalent cancer in Canada, preceded by breast and prostate cancers.
- Based upon the number of new cases in 2009, colorectal cancer is ranked 4th behind prostate, lung, and breast cancers.
- Regular colonoscopies every 3 years can detect almost 100% of colorectal cancers. Early cancer identification is essential for successful treatment.
- Colorectal cancer is the 2nd most expensive cancer to treat, just behind lymphatic cancers.
- Each hospital admission for a colorectal cancer patient costs an average of $13,000 (on average, how many admissions?)
- In 2009, 22,000 Canadians will be diagnosed with colorectal cancer.
- In 2009, estimates show colon, rectum and anus cancers will kill 9,100 Canadians.
- The lifetime probability of a Canadian developing colorectal cancer is 1 in 15.
- The lifetime probability of a Canadian dying from colorectal cancer is 1 in 27.
- Canadians aged 70 to 79 years have a 12-fold increased chance of developing colorectal cancer over the next 10 years when compared to those aged 40 to 49 years.
- Lifetime medical treatment costs for colon cancer can be as high as $0.75 million per patient.
- Stomach cancer is the 2nd leading cause of death in the world.
- Infection with the bacteria Helicobacter pylori, which causes ulcers, increases the risk for stomach cancer by as much as 6x
- 1 in 20 stomach ulcers are cancerous. Only 1 in 5 stomach cancer patients will survive longer than 5 years.
- In 2008, nearly 1,600 Canadians died from stomach cancer. For 2009, this disease is estimated to kill 1,850 Canadians.
- Canadian males aged 80 to 89 have a 7 times greater risk of developing stomach cancer than they did in their fifties.
- Canadian females aged 80 to 89 have a 4-fold increased risk of developing stomach cancer than they did in their fifties.
- Overweight and obese individuals have an increased risk for developing stomach cancer.
- The majority of esophageal cancer patients will die within five years of diagnosis.
- In 2008, 1,350 Canadians died from esophageal cancer. It is estimated that 1,600 – 1,800 Canadians will be diagnosed with esophageal cancer in 2009.
- Three out of every four esophageal cancer patients are male.
- Over the next 10 years, Canadian males 70 years + represent the highest at-risk group for developing esophageal cancer.
- At the end of 5 years, only 1 in 7 esophageal cancer patients will be alive.
- Obesity significantly increases the risk for developing esophageal cancer.
- Acute care for patients with diseases of the esophagus total $52 million each year in Canada.
- Over 3,000 Canadians died from pancreatic cancer in 2008. In 2009, the number of deaths is expected to be 3,900.
- The vast majority of pancreatic cancer patients are between 60 and 80 years old.
- Canadians in their eighties have a two-fold increased risk of developing pancreatic cancer relative to those in their sixties.
- At the end of five years, only 3 in 50 pancreatic cancer patients will be alive.
- Primary liver cancer has become the fifth most common form of cancer in the world.
- Although considered uncommon, in 2008, more than 2,500 Canadians died from liver and biliary cancers.
- After 5 years, only 1 in 10 patients with liver and biliary cancers will still be alive.
- Immigrants to Canada have a high rate of liver cancer relative to non-immigrants.
- Bile duct cancer patients typically survive for only 4 to 6 months.
- People with gallstone disease have a 3-fold increased chance of developing cancer of the gall bladder.
Liver and Biliary
- Direct costs associated with diverticular disease are $88.6 million per year.
- The management of diverticular disease costs Canadians $90.3 million each year.
- 50% of Canadians over the age of 80 years develop diverticular disease.
- The high rate of hospitalization and surgery makes diverticular disease one of the 5 most expensive digestive diseases to manage ahead of irritable bowel syndrome and inflammatory bowel diseases.
- The risk for symptomatic diverticular disease is negligible for 35 year olds or younger. However, at age 55 the risk increases by a factor of 10 and at 75 years the risk has increased to 40.
- In Ontario, the prevalence of symptomatic diverticular disease necessitating hospitalization is three times higher than the national average.
- Every year, more than 400 Canadians die due to complications associated with diverticular disease.
- Each year 3,309 Canadians require life-saving surgical intervention to treat their diverticular disease.
- In excess of 130,000 Canadians have diverticular disease.
- In Canada, 13,000 people each year are admitted to hospital for diverticular disease.
- Recurrent bleeding episodes in patients with diverticulosis dramatically increases healthcare costs for this disease.
- At present, there are no known risk factors other than advanced age.
- In total, hospital care for peptic ulcer disease costs $67 million per year.
- There are between 500,000 to 850,000 Canadians diagnosed with duodenal ulcers.
- Since 1996, the number of Canadians with ulcers has increased 1.5 times.
- In-hospital costs for complicated and uncomplicated ulcers total nearly $9 million per year for more than 2,500 Canadians. Complicated ulcer patient care costs are 1.5 times more than for those with uncomplicated ulcers.
- The prescribing practice of proton pump inhibitors has been associated with a concomitant decline in the number of individuals with peptic ulcer disease.
- Although peptic ulcer disease has declined due to improved medical treatments, peptic ulcer bleeding rates remain unchanged. This is primarily attributed to a growing elderly population with an increased usage of NSAIDs
- The average length of stay in hospital for patients with ulcers has been reduced to 7 ½ days from almost 9 days
- Proton pump inhibitor drugs or acid suppression therapy decreases the incidence and severity of duodenal ulcers.
- In Canada, H. pylori eradication therapy costs $90 per person and is 80-90% effective. A second round of therapy in instances of resistance costs a total of $275.
- Worldwide sales for indigestion and heartburn remedies totaled $CDN 9.1 billion in 2008.
- Canada is ranked as the 12th largest consumer of indigestion and heartburn remedies in the world. In 2008, Canadian sales were $164 million. This is a substantial increase from 2003 in where sales totaled just $108 million.
- Patients concerns about indigestion costs the Canadian health care system $460 million each year.
- In the 1980s, the average length of hospital stay for dyspeptic patients was 7 days. Since 2002, this has decreased to 5 days reducing the economic burden of this disease by $16.3 million per year).
- The risk for developing Barrett's esophagus in dyspeptic patients is higher than for non-dyspeptic patients. The disease is considered a premalignant condition that may lead to progressive dysplasia and adenocarcinoma.
- In Canada, the majority of dyspepsia sufferers have erosive esophagitis which responds well to acid suppressive prescription drugs.
- It is estimated that there are 1.3 million Canadians with stomach ulcers.
- Every 1 in 10 Canadians will develop a stomach ulcer at some point in their lifetime.
- Canadians received 12.4 million prescriptions in 2004 for proton pump inhibitors.
- Bleeding stomach ulcers are associated with a significant mortality rate of 1 death in 20 cases.
- Certain acid suppressing drugs are more effective for patients with stomach ulcers even though they cost up to $2.20 more/day
- People advised to take non-steroidal anti-inflammatory drugs (NSAIDs) on a daily basis should also be tested/treated for H. pylori infection and prescribed acid suppressing medication on a daily basis to prevent the development of stomach ulcers.
- Provincial health care programs have tried twice to limit access to proton pump inhibitor therapy in Newfoundland and, most recently, in British Columbia. In BC, the program cost an estimated $43.5 million instead of providing the predicted savings of $42 million. This emphasizes the importance of proton pump inhibitor therapy and its long-term cost effectiveness with respect to usage of the health care system.
- Obesity has been positively associated with an increased risk for developing stomach ulcers in addition to smoking and aspirin use.
- On average, 5 million Canadians experience heartburn and/or acid regurgitation at least once each week.
- GERD patients are absent from work 16% of each year due to their symptoms. In Canada, this represents a workforce productivity loss of 1.7 billion hours amounting to $21 billion every year.
- Canadians received 12.4 million prescriptions for Proton Pump Inhibitors in 2004.
- 42% of GERD patients are dissatisfied with the outcome of drug therapy
- Increasing age is recognized as a primary risk factor for the development of GERD.
- Moderate or severe symptoms of GERD and GER are indicative of a chronic disease that persists for at least 18 years.
- Similar to other arctic areas, Canadian arctic residents have a two-fold higher prevalence of hepatitis A and B chronic infections compared to the southern areas of the country.
- The mean cost per hospital stay for a hepatitis patient is $12,000. In 2004-2005, hospital stays for hepatitis cost more than $7 million.
- Each year, more than 600 Canadians are hospitalized for hepatitis.
- Hepatitis A infected people are absent from work for 27 days representing a productivity loss of over $3,000.00 per person.
- Hepatitis A viral infection cannot be treated by conventional therapies and analgesics may harm the stressed liver.
- Canadians over the age of 60 years are most susceptible to hepatitis A infection and have the highest mortality rate of any infected age group.
- Travel to the United States in the 1990s accounted for 1 in 5 hepatitis A infections in Canadians.
- Only 1 out of every 20 Canadians who travel internationally are immunized against hepatitis A. Out of every 6 cases of hepatitis A, at least one was acquired during international travel to an endemic country. Hepatitis B – blood borne transmission and contaminated organ contact
- Hepatitis B viral carriers are at considerable risk for the development of liver disease or damage.
- In 2008, there was approximately 270,000 Canadians infected with hepatitis B.
- Between 1990 and 2015, the health care costs for hepatitis C virus related diseases will quadruple in North America.
- There is one therapy available for hepatitis C infection. Only 1 out of 2 every patients can tolerate and respond as anticipated to the therapy.
- Hepatitis C virus infection is the underlying cause for the development of deadly liver diseases.
- The hepatitis C virus is one of the top 10 causes of deaths due to infectious diseases, worldwide.
- As in the United States, the economic burden of hepatitis C infection is expected to increase in Canada as there is no vaccine or prophylaxis available.
- Each year, 470 Canadians acquire the hepatitis C while the national prevalence is 270,000 cases.
- Canadian injection drug users in major city centres have a 10-fold greater risk of acquiring hepatitis C infection than HIV.
- One third of costs associated with hepatitis C infection are due to direct medical care costs while two thirds involve productivity and work related costs.
- In the Canadian arctic, 3 out of every 100 First Nations people are infected with the hepatitis E virus.
- Commercial piggeries are known to harbor the hepatitis E virus strain that infects humans.
- The hepatitis E virus may be more common than previously believed in industrialized nations with prevalence rates equal to or greater than hepatitis A.
- Elderly men appear most susceptible to hepatitis E virus infections.
- Hepatitis G co-infects alongside hepatitis C or B or HIV.
- Out of every 100 Canadians, 3 people are infected with hepatitis G.
- Hepatitis G viral infections can last for up to 9 years in adults yet it is unknown if the liver is affected in any way.
Hepatitis A – transmission via fecal-oral, person-to-person contact, water, or food
Hepatitis C – mainly blood borne or blood product transmission, sharing personal items
Hepatitis E – possible porcine source, transmission via fecal-oral, contaminated water/food
Hepatitis G – blood borne or blood product transmission or sharing of personal items
- A crude estimate of the Canadian prevalence of H. pylori is 8 to 10 million people.
- In First Nation communities, approximately 75% of the people are infected with H. pylori.
- H. pylori infection is considered to be a carcinogen by WHO as it is associated with the development of stomach cancer.
- In communities with a high prevalence of H. pylori infection, treated individuals have a 1 in 10 chance of re-infection after one year.
- In Canada, H. pylori eradication therapy costs $90 per person and is 80-90% effective. A second round of therapy in instances of resistance costs a total of $275.
- H. pylori infection rates in Canadians increase with age. The infection rate for thirty-year olds is 1 in 5 people or 1 million people. This increases to 1 in every 2 people aged eighty-years or older or 0.5 million persons.
- Stomach and duodenal ulcers are not caused by stress but by Helicobacter pylori infection.
- H. pylori infection is one of the causes of functional dyspepsia.
- Men have a higher rate of H. pylori infection than women.
- The Canadian population groups considered high risks for H. pylori infection totals 4,137,475, based upon origin of birth and/or area of residence. Testing and eradication costs for this sub-group are estimated to be $350 million.
- Canada has one of the highest incidence and prevalence rates of inflammatory bowel disease in the world.
- The total direct and indirect costs of IBD are $1.8 billion
- The total direct medical costs for IBD were $700 million in 2008.
- In 2008, the cost of prescription drugs for the treatment of Canadian patients with IBD was $162 million ($809/patient)
- Costs associated with additional physician visits and outpatient surgeries cost $134 million in 2008.
- Indirect costs associated with IBD total in excess of $1 billion with the main contributor being long-term work loss.
- Sick leave and absenteeism attributes to IBD cost the Canadian economy $104.2 million per year.
- Absenteeism and early retirement due to IBD is estimated to cost the Canadian market $746 million
- In a single year, the Canadian workforce suffers a productivity loss of $138 million due to short-term absences of IBD patients.
- In 2008, there were an estimated 250,000 Canadians with IBD
- The average age of IBD onset coincides with an individual's most important socioeconomic period of their life. As such, the indirect costs of IBD are enormous as symptom severity may prevent a patient from realizing their career potential or family creation.
- Prince Edward Island has the highest prevalence of IBD in Canada. Ontario has the most IBD cases.
- Malnutrition and blood disorders are common conditions in IBD patients found to be caused by avoiding food items either because of existing symptoms or concern that they may bring on symptoms.
- Complimentary and alternative medicines are used at some point by half of all IBD patients. Costs associated with these medicines are not covered by health care plans.
- Almost half of IBD patients have additional health issues affecting their joints, skin, eyes, and biliary tract that may be more debilitating than the bowel symptoms.
- The next generation of IBD drugs, referred to as "biologicals", cost $10,000 per patient per year. These drugs have been credited for reducing hospitalization and surgery costs for IBD patients.
- Canada has one of the highest rates of IBS in the world.
- 5 million Canadians suffer from IBS with 120,000 Canadians developing IBS each year
- Each year, the economic and health care burden of IBS is in excess of $6.5 billion. This does not include monies spent on either over-the-counter drugs or prescriptions.
- A patient with IBS misses an average of 13 work days a year. At $72.60, this indirect cost represents $8 billion of lost productivity each year.
- About 40% of IBS sufferers seek medical attention. Those with milder symptoms typically end up self-treating through life style changes, food avoidance, and non-prescription remedies.
- Patients with IBS represent the majority of referrals to gastroenterologists.
- IBS affects more women than men.
- Maritime provinces have the highest rates of IBS in Canada with Newfoundland coming in first place.
- Acute care inpatient costs for IBS are ranked as the 4th most expensive digestive disease in Canada.
- Obesity enhances the severity of IBS symptoms
- Lactose intolerance affects more than 7 million Canadians. This is likely an underestimate as many individuals do not associate their symptoms with lactose-containing foods or are asymptomatic.
- For individuals who seek medical attention for their symptoms, physicians only submit 10% for clinical testing specifically for lactose intolerance. Since only 10% of symptomatic patients are clinically tested (294,000 people), it appears that Canadian physicians underestimate the daily impact of chronic lactose intolerance symptoms.
- 25% of patients, clinically identified as lactose intolerant, have celiac disease. In Canada, that means 73,500 people have undiagnosed celiac disease which is the causal agent for their lactose intolerance.
- A digestive disease patient may consume 10 g or more of lactose each day from their drugs.
- Lactose intolerant people who use a lactase containing product will spend over $500 per year. These costs are not covered by insurance plans as the product is sold over-the-counter.
- Lactose intolerant people who avoid dairy products should be taking calcium supplements. The recommended daily intake of calcium is 1,000 mg for adults and 1,300 mg for those over the age of 50 years. The annual cost per person taking 750 mg calcium per day ranges from $50 to $75. Again, these costs are not covered by insurance plans as products are sold over-the-counter.
- In hospital expenses for 2,534 cases of liver disease averaged $4,500 per patient in 2005-2006, totaling $11.1 million.
- A liver disease, primary biliary cirrhosis, is believed to have a genetic basis as 1/3 of the patients have a family history of liver disease.
- There are 740 Canadians living with primary biliary cirrhosis. There are 110 new cases each year in Canada.
- There are 146 babies born each year with liver disease in Canada.
- 2,788 Canadians die each year from liver diseases.
- The number of Canadians dying each year from "all" liver diseases is greater than 7,000.
- Hospitalized patients with liver disease have longer than expected length of stays relative to other digestive diseases.
- 75% of liver diseases are diagnosed within the first two years of the patient experiencing symptoms. For the remaining individuals, their diagnoses may take as long as 13 years. Individuals with liver disease usually make 3.5 visits to their physicians before receiving a diagnosis.
- Disorders of the hepatobiliary tract cost an average of $3,000 per patient per hospital stay. In 2005-2006, hospitalization costs for 10,397 patients were $30 million.
- Where possible, patients with liver disease may be suitable for a liver transplant which costs on average $54,000. Approximately 1/3 of organ transplant patients undergo rejection costing an addition $6,500 per patient. Overall, the mortality rate with organ transplant and rejection is 13%.
- High consumption of alcohol is a well-described cause of alcoholic cirrhosis of the liver.
- Acute care inpatient costs for pancreas diseases are ranked as the 5th most expensive digestive disease in Canada costing $120 million per year for 13,000 patients.
- In the US, the direct health care costs of acute pancreatitis cost 2.2 billion USD (should translate to $200 million Cdn)
- Pancreatitis affects 1 million Canadians.
- Acute pancreatitis affects more than 600,000 Canadians
- Chronic pancreatitis affects more than 300,000 Canadians
- Obesity is a well-known risk factor for developing severe, acute pancreatitis. The "obesity epidemic" of the western world will likely increase the total number of patients within the next few decades.
- In 2008, $21 million was spent on prescription drugs for the treatment of ulcerative colitis.
- Every year, 1 person out of every 20 patients with Crohn's disease or ulcerative colitis is hospitalized.
- Half of all ulcerative colitis patients will be hospitalized at some point while less than 1/5 will require surgery.
- Each hospital stay costs $9,400 and the total cost for 2008 has been estimated to be $120 million.
- Ulcerative colitis is most commonly diagnosed in people aged 20 or older.
- Worldwide, there are 189 pharmaceutical products indicated ulcerative colitis and 53 pharmaceutical products currently in clinical trials
- Over the last 25 years, the average length of hospital stay for IBD patients has decreased from 15 to 9 days. This decrease achieves a cost savings of $4,000 per IBD patient for a total of $28 million.
Inflammatory Bowel Disease
Irritable Bowel Syndrome