Szigethy E¹, Murphy SM², Ehrlich OG³, Engel-Nitz NM⁴, Heller CA³, Henrichsen K⁵, Lawton R⁶, Meadows P⁷, Allen JI^8,9. Inflamm Bowel Dis. 2020 Feb 25. pii: izaa030. doi: 10.1093/ibd/izaa030. [Epub ahead of print]

Author information

1 Department of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, PA.

2 Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY.

3 Crohn's & Colitis Foundation, New York, NY.

4 Optum, Eden Prairie, MN.

5 Medical Management, Centene Corporation, St. Louis, MO.

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

7 Medical Director, Government Programs, Geisinger Health Plan.

8 University of Michigan School of Medicine, Ann Arbor, MI.

9 Institute for Healthcare Policy and Innovation, Ann Arbor, MI.

Abstract

BACKGROUND: Mental health diagnoses (MHDs) were identified as significant drivers of inflammatory bowel disease(IBD)-related costs in an analysis titled "Cost of Care Initiative" supported by the Crohn's & Colitis Foundation. In this subanalysis, we sought to characterize and compare IBD patients with and without MHDs based on insurance claims data in terms of demographic traits, medical utilization, and annualized costs of care.

METHODS: We analyzed the Optum Research Database of administrative claims from years 2007 to 2016 representing commercially insured and Medicare Advantage insured IBD patients in the United States. Inflammatorybowel disease patients with and without an MHD were compared in terms of demographics (age, gender, race), insurance type, IBD-related medical utilization (ambulatory visits, emergency department [ED] visits, and inpatient hospitalizations), and total IBD-related costs. Only patients with costs >$0 in each of the utilization categories were included in the cost estimates.

RESULTS: Of the total IBD study cohort of 52,782 patients representing 179,314 person-years of data, 22,483 (42.6%) patients had at least 1 MHD coded in their claims data with a total of 46,510 person-years in which a patient had a coded MHD. The most commonly coded diagnostic categories were depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Compared with patients without an MHD, a significantly greater percentage of IBD patients with MHDs were female (61.59% vs 48.63%), older than 75 years of age (9.59% vs 6.32%), white (73.80% vs 70.17%), and significantly less likely to be younger than 25 years of age (9.18% vs 11.39%) compared with those without mental illness (P < 0.001). Patients with MHDs had significantly more ED visits (14.34% vs 7.62%, P < 0.001) and inpatient stays (19.65% vs 8.63%, P < 0.001) compared with those without an MHD. Concomitantly, patients with MHDs had significantly higher ED costs ($970 vs $754, P < 0.001) and inpatient costs ($39,205 vs $29,550, P < 0.001) compared with IBD patients without MHDs. Patients with MHDs also had significantly higher total annual IBD-related surgical costs ($55,693 vs $40,486, P < 0.001) and nonsurgical costs (medical and pharmacy) ($17,220 vs $11,073, P < 0.001), and paid a larger portion of the total out-of-pocket cost for IBD services ($1017 vs $905, P < 0.001).

CONCLUSION: Patients whose claims data contained both IBD-related and MHD-related diagnoses generated significantly higher costs compared with IBD patients without an MHD diagnosis. Based on these data, we speculate that health care costs might be reduced and the course of patients IBD might be improved if the IBD-treating provider recognized this link and implemented effective behavioral health screening and intervention as soon as an MHD was suspected during management of IBD patients. Studies investigating best screening and intervention strategies for MHDs are needed.