Systematic review: costs of ulcerative colitis in Western countries.Cohen RD, Yu AP, Wu EQ, Xie J, Mulani P, Chao J. Aliment Pharmacol Ther. 2010 Jan 11. [Epub ahead of print] SUMMARY Background Early onset and complications such as hospitalization and surgery contribute to the economic burden of ulcerative colitis (UC). Aim To systematically review the literature on UC costs in Western countries. Methods Studies estimating costs of UC in Western countries were identified using Medline, EMBASE, and ISI Web of Science and were rated based on relevance and reliability of estimates. All costs were adjusted to 2008 currency values. A parallel review focused on the impact of disease severity on costs, hospitalizations, and surgeries. Results Estimated annual per-patient direct medical costs of UC ranged from $6,217-$11,477 in the United States and euro8,949-euro10,395 in Europe. Hospitalizations accounted for 41-55% of direct medical costs. Indirect costs accounted for approximately one-third of total costs in the United States and 54-68% in Europe. Total economic burden of UC was estimated at $8.1-14.9 billion annually in the United States and euro12.5-29.1 billion in Europe; total direct costs were $3.4-8.6 billion in the United States and euro5.4-12.6 billion in Europe. Direct costs, hospitalizations, and surgeries increased with worsening disease severity. Conclusions UC is a costly disease. Hospitalizations contribute significantly to direct medical costs, and indirect costs are considerable, having previously been substantially underestimated.