Park KT¹, Ehrlich OG², Allen JI³, Meadows P⁴, Szigethy EM⁵, Henrichsen K⁶, Kim SC⁷, Lawton RC⁸, Murphy SM⁹, Regueiro M¹⁰, Rubin DT¹¹, Engel-Nitz NM¹², Heller CA². Inflamm Bowel Dis. 2019 May 21. pii: izz104. doi: 10.1093/ibd/izz104. [Epub ahead of print]

Author information

1 Stanford University School of Medicine & Stanford Health Care, Palo Alto, CA, USA.

2 Crohn's & Colitis Foundation, New York, NY, USA.

3 Division of Gastroenterology and Hepatology, University of Michigan School of Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.

4 Medical Director, Government Programs, Geisinger Health Plan, Danville, PA, USA.

5 Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

6 Medical Management, Centene Corporation, St. Louis, MO, USA.

7 Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

8 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.

9 Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.

10 Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA.

11 Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.

12 Optum, Eden Prairie, MN, USA.

Abstract

BACKGROUND: The Crohn's & Colitis Foundation's Cost of Inflammatory Bowel Disease (IBD) Care Initiative seeks to quantify the wide-ranging health care costs affecting patients living with IBD. We aimed to (1) describe the annualized direct and indirect costs of care for patients with Crohn's disease (CD) or ulcerative colitis (UC), (2) determine the longitudinal drivers of these costs, and (3) characterize the cost of care for newly diagnosed patients.

METHODS: We analyzed the Optum Research Database from the years 2007 to 2016, representing commercially insured and Medicare Advantage-insured patients in the United States. Inclusion for the study was limited to those who had continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months before through 12 months after the index date of diagnosis). The value of patient time spent on health care was calculated as number of workplace hours lost due to health care encounters multiplied by the patients' estimated average wage derived from the Bureau of Labor Statistics. Comparisons between IBD patients and non-IBD patients were analyzed based on demographics, health plan type, and length of follow-up. We used generalized linear models to estimate the association between total annual costs and various patient variables.

RESULTS: There were 52,782 IBD patients (29,062 UC; 23,720 CD) included in the analysis (54.1% females). On a per-annual basis, patients with IBD incurred a greater than 3-fold higher direct cost of care compared with non-IBD controls ($22,987 vs $6956 per-member per-year paid claims) and more than twice the out-of-pocket costs ($2213 vs $979 per-year reported costs), with all-cause IBD costs rising after 2013. Patients with IBD also experienced significantly higher costs associated with time spent on health care as compared with controls. The burden of costs was most notable in the first year after initial IBD diagnosis (mean = $26,555). The study identified several key drivers of cost for IBD patients: treatment with specific therapeutics (biologics, opioids, or steroids); ED use; and health care services associated with relapsing disease, anemia, or mental health comorbidity.

CONCLUSION: The costs of care for IBD have increased in the last 5 years and are driven by specific therapeutics and diseasefeatures. In addition, compared with non-IBD controls, IBD patients are increasingly incurring higher costs associated with health care utilization, out-of-pocket expenditures, and workplace productivity losses. There is a pressing need for cost-effective strategies to address these burdens on patients and families affected by IBD.