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A nationwide 2010-2012 analysis of U.S. health care utilization in inflammatory bowel diseases
Welmoed K van Deen1, Martijn G H van Oijen, Kelly D Myers
1*UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; †Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; ‡Qforma Inc., Santa Fe, New Mexico; and §Department of Surgery, and ‖Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Background:
Implementation of the 2010 Affordable Care Act (ACA) calls for a collaborative effort to transform the U.S. health care system toward patient-centered and value-based care. To identify how specialty care can be improved, we mapped current U.S. health care utilization in patients with inflammatory bowel diseases (IBD) using a national insurance claims database.
Methods:
We performed a cross-sectional study analyzing U.S. health care utilization in 964,633 patients with IBD between 2010 and 2012 using insurance claims data, including pharmacy and medical claims. Frequency of IBD-related care utilization (medication, tests, and treatments) and their charges were evaluated. Subsequently, outcomes were put into the framework of current U.S. guidelines to identify areas of improvement.
Results:
A disproportionate usage of aminosalicylates in Crohn's disease (42%), frequent corticosteroid use (46%, with 9% long-term users), and low rates of corticosteroid-sparing drugs (thiopurines 15%; methotrexate 2.7%) were observed. Markers for inflammatory activity, such as C-reactive protein or fecal calprotectin were not commonly used (8.8% and 0.13%, respectively). Although infrequently used (11%), anti-TNF antibody therapy represents a major part of observed IBD charges.
Conclusions:
This analysis shows 2010-2012 utilization and medication patterns of IBD health care in the United States and suggests that improvement can be obtained through enhanced guidelines adherence.
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