Background and objective: Inflammatory bowel disease (IBD) represents a growing clinical and economic challenge for healthcare systems, particularly in settings that provide free access to specialised care. Advances in medical therapy have modified disease outcomes but have also reshaped healthcare expenditure, while surgical management continues to represent high-impact cost events. Integrated analyses comparing medical and surgical costs from the perspective of public healthcare systems remain scarce in Latin America. This study aims to compare the economic burden of medical versus surgical-hospital management in patients with IBD by quantifying cumulative direct costs over 12 months from an institutional perspective using real-world data. Patients and methods: A retrospective observational study using real-world data was conducted at the Inflammatory Bowel Disease Clinic of the Coloproctology Service, Hospital General de México “Dr. Eduardo Liceaga," a tertiary-level public referral hospital in Mexico City. A total of 118 patients (100%) with confirmed IBD managed over 12 months were included. Patients were categorized according to medical or surgical-hospital management. Direct costs related to pharmacological treatment, hospitalization, and surgical care were quantified from an institutional perspective and analyzed descriptively. Results: Among the 118 patients included (100%), 95 (80.5%) had ulcerative colitis and 23 (19.5%) had Crohn’s disease. Medical management was required in 91 patients (77.1%), including advanced therapies in 27 (22.9%). Surgical-hospital management was necessary in 24 patients (20.3%). The cumulative annual cost of medical management for the cohort was Mexican peso (MXN) 16.4 million. In contrast, surgical-hospital management generated a total accumulated cost of MXN 15.0 million, despite involving a substantially smaller proportion of patients. Overall, approximately 95% of direct healthcare costs were absorbed by the public institution within a free-access care model. Conclusions: In a public referral hospital, the economic burden of IBD reflects both sustained pharmacological investment and high-impact surgical events. The comparable magnitude of cumulative medical and surgical expenditures underscores the need to interpret healthcare costs in relation to clinical trajectories rather than patient volume alone, supporting value-oriented strategies to optimize resource allocation in publicly funded healthcare systems.
Rodríguez et al. (Mon,) studied this question.