A claims-based Markov model for Crohn's disease

Area of Science:

• Gastroenterology
• Health Economics
• Chronic Disease Management

Background:

• Crohn's disease (CD) is a chronic inflammatory bowel disease typically diagnosed in early adulthood.
• Effective management of CD requires understanding its long-term health care cost implications.

Purpose of the Study:

• To evaluate the health care costs associated with Crohn's disease.
• To determine the cost per quality-adjusted life year (QALY) for different disease severity states in Crohn's disease.

Main Methods:

• A Markov model was developed using administrative claims data from 40,063 adult patients with at least two CD claims and three years of continuous enrollment.
• Disease states were defined as remission, mild-moderate, moderate-severe, and severe-fulminant based on American College of Gastroenterology criteria.
• Transition probabilities between states were calculated, and costs were derived from paid claims, with QALY utilities sourced from literature.

Main Results:

• The study analyzed 420,773 cycles across disease states: remission (46.8%), mild-moderate (10.5%), moderate-severe (31.5%), and severe-fulminant (11.2%).
• Costs per QALY varied significantly by disease state and sex: remission ($2896), mild-moderate ($8428 male, $8426 female), moderate-severe ($11,518 male, $22,633 female), and severe-fulminant ($69,277 male, $69,412 female).

Conclusions:

• Health care costs for Crohn's disease patients demonstrably increase with disease severity.
• Despite low transition probabilities, the severe-fulminant disease state presents a high cost per QALY, highlighting the economic burden of advanced Crohn's disease.