The cost of Crohn’s can be measured in many ways, not all of them financial. However, the financial costs for Crohn’s health care are in some ways easier to evaluate, so let’s start with those.
If you’re on Remicade, you will probably need eight intravenous treatments a year. Without insurance, the cost of that is $12,000. If you don’t have insurance, and can’t get Medicare or Medicaid, you probably won’t be able to afford it. Remicade is one of the newer drugs, similar to Humira, which works as an antibody to tumor necrosis factor-alpha (TNF-alpha). These drugs are the most effective at reducing the symptoms of Crohn’s and stopping or preventing flares.
Another type of drug is aminosalicylates. They suppress the patient’s ability to produce prostaglandins, or chemicals that cause swelling of tissues, so they reduce the chronic inflammation of Crohn’s. One such drug is Pentasa. It averages $212 for a three-month supply.
Many Crohn’s patients take antibiotics along with other treatments. Since many of them are available as generic drugs, unlike Remicade, they are much less expensive. A month of Flagyl costs about $12, for the generic version. Immunosuppressants are often prescribed as well. Without insurance, the cost of a month of Imuran, one such drug, is about $450 in the United States.
What about testing? The average cost of a colonoscopy, a test all Crohn’s patients are familiar with, is just over $3,000, without insurance. It could be much higher, depending on where you live.
If you didn’t have insurance before being diagnosed with Crohn’s, you’ll have a very hard time getting it, unless you are eligible for Medicare or Medicaid. With Medicare, as with most private insurance companies, you must pay a monthly premium. While it covers clinic visits, hospital stays and some testing, it doesn’t cover medication. You’ll need a Medicare part D plan for prescription drugs, which costs vary by location as well. Private insurance can cost $4,000 a year in premiums or more, and the actual coverage you get for that amount varies widely. For example, some insurance companies have set co-pays for prescriptions or doctor visits, while others cover a percentage of the cost. Some employers have health care savings plans, where you put part of your income into a health care account, and that money is used to cover your medical expenses. Medical insurance in the U.S. is a topic for an article of its own. Make sure your insurance provides hospital coverage, because it is almost certain that at some point, you will require surgery.
None of these numbers take into account the cost of the patient’s time. One study found that assuming the patient was making the U.S. national average wage; the cost for the patient’s time for a colonoscopy is $423. Clearly it will be higher if your wage is higher, or your doctors are slower.
Similarly, there are no studies that take into account the emotional cost of dealing with Crohn’s. OK, it’s not a dollar figure; it’s not something you can add up. Unless you’re in therapy; then the average cost for a 50 minute “hour” is around $200, but will vary by where you live. And unlike other types of health coverage, mental health care is often paid at a lower percentage or for a limited number of visits. Crohn’s can cost you time away from work, time away from your family and friends, and time away from doing the things you love to do that have always made your life worthwhile. But I digress from the topic.
Your grocery budget will be changing too. How it changes depends on your condition at the time you shop. While doctors agree that Crohn’s patients need a balanced diet, they disagree on how much of that diet should be fresh fruits and vegetables, and how much fiber you should consume. If you’re between flares and can tolerate them, then look for the freshest produce you can find. And if you need to pay extra to get organic and pesticide-free produce, then do it, because Crohn’s patients are far more likely to have a bad reaction to pesticides than the general population. Limit your fat intake. Fat is difficult for your intestines to process, and can trigger a flare. Limit your sugar intake. Like fat, sugar can cause a flare and has empty calories that you don’t need unless you’re trying to gain weight, which many Crohn’s patients need to do. Fresh low-fat foods cost more than their canned, sugar-added counterparts.
If you’re having a flare, you’ll want to choose bland and low-fiber foods. Just as organic produce costs more than the regular product, a healthy, bland food, such as Cream of Wheat TM cereal, can cost more than a store brand with higher fiber content. When you know what you need to be eating, you’ll be able to make a grocery budget that is specific to your needs.
When you plan your monthly budget, first include the fixed costs, like rent or a mortgage payment, utilities, and possibly a car payment. From there on, try to cut costs wherever you can. Calculate how many trips you’ll be making to your doctor’s office in a month, and how much gas that will take. It can be extremely difficult, if not impossible, for a Crohn’s patient who is having a flare to use public transportation. City buses rarely come with restrooms. Choosing to ride a bicycle is just as impossible for a Crohn’s patient. If you are eligible for disability, you may find that your community provides free transportation for you to get to the places you need to go. Look into that before you use half your income on gasoline.
When you’re grocery shopping, look for store-brand items (non-produce) as much as possible. They’ll save you money that you’ll need for health care. Use coupons whenever you can get them, and switch grocery stores to get the lowest prices on what you need in any given week. Buy in bulk and freeze foods if you can. Get generic medications whenever possible, although that possibility is limited. If you and a neighbor can shop together and take turns driving, this will help to save on gas and may help you spend less as well. Shop with cash rather than credit cards or checks. Most people are less likely to make impulse buys or purchase things they don’t really need if they have only the cash with them.
At home, keep your house warmer in the summer and cooler in winter and wear warmer clothes. Cut back on watering. Turn off lights when you leave a room and only turn on the lights you need. It may seem like a small savings at first, but it does add up.
Look at some of the Crohn’s support Web sites, like the Crohn’s and Colitis Foundation of America (CCFA) Web site for more information about health care costs and saving money. It’s hard to predict what the economy will do, but at this point, it does seem that everything is becoming more expensive. There’s no reason to believe that medications won’t, as well. It is possible to get some Crohn’s medications over the Internet, but look into the legality of it before you do it. Not knowing something is illegal doesn’t get you out of being penalized for doing it.
