Optimizing the quality of care for the IBD patient in evolving economies

Abstract

Inflammatory bowel disease (IBD) was once a rare disease in Asia. However, both the incidence and prevalence of IBD are rising rapidly in Asia resulting in a pressing need for quality care of IBD patients in this region. Optimal management of IBD requires expertise and is usually expensive. The goals of treatment have been evolved from short-term symptom control to long-term prevention of IBD related complications and even histological remission. There are, however, many barriers that limit the delivery of the best quality care to IBD patients in this region. First, a team effort including the contribution from gastroenterologists, colorectal surgeons, radiologists, dietitians and nurse specialists is required, which make it difficult for small units with limited resources. Second, the frequent use of endoscopic and radiological imaging for patients with IBD would have major impact on health care utilization and prioritization. Many laboratory tools useful in monitoring the disease is also not widely available in this region such as fecal calprotectin test, measurements of thiopurine metabolites and trough levels of biologics, etc. Third, new pharmacological treatments for IBD, particularly biologics, are costly and may not be covered by insurances or the national health care system in many Asian countries. There are major financial difficulties for many IBD patients to initiate or maintain on biologics. Despite the availability of biosimilars in some Asian countries, the actual cost saving is not substantial. Hence, there is a genuine need to characterize the role of other non-biologic agents in management of IBD in this region such as thalidomide, methotrexate or tacrolimus, etc. There are still a lot of tasks for the Asian IBD clinicians to accomplish and it is an exciting moment to witness the rapid changes in practices of IBD management in Asia.