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The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn's & Colitis Foundation
K T Park1, Orna G Ehrlich2, John I Allen3
1Stanford University School of Medicine & Stanford Health Care, Palo Alto, CA, USA.
Insights
Inflammatory Bowel Disease (IBD) care costs are over three times higher for patients than controls, driven by treatments and disease factors. Costs are highest in the first year post-diagnosis, highlighting a need for cost-effective strategies.
Area of Science:
- Gastroenterology
- Health Economics
- Public Health
Background:
- The Crohn's & Colitis Foundation initiated a study to quantify the extensive healthcare costs associated with Inflammatory Bowel Disease (IBD).
- IBD encompasses conditions like Crohn's disease (CD) and ulcerative colitis (UC), significantly impacting patients' financial well-being.
- Understanding these costs is crucial for developing supportive patient care strategies.
Purpose of the Study:
- To describe the annual direct and indirect costs of care for patients with Crohn's disease (CD) or ulcerative colitis (UC).
- To identify the longitudinal factors that drive these healthcare expenditures over time.
- To characterize the specific costs incurred by patients newly diagnosed with IBD.
Main Methods:
- Analysis of the Optum Research Database (2007-2016) for commercially insured and Medicare Advantage patients in the U.S.
- Inclusion criteria required continuous enrollment for at least 24 months around the diagnosis index date.
- Patient time costs were calculated using lost work hours and average wages; statistical models estimated cost associations.
Main Results:
- IBD patients incurred over three times higher direct costs ($22,987/year) and double the out-of-pocket costs ($2213/year) compared to non-IBD controls.
- Costs rose after 2013, with the highest burden in the first year post-diagnosis (mean $26,555).
- Key cost drivers included biologics, opioids, steroids, emergency department visits, and comorbidities like anemia and mental health issues.
Conclusions:
- Healthcare costs for IBD have escalated, influenced by specific therapeutics and disease characteristics.
- IBD patients face significantly higher healthcare utilization, out-of-pocket expenses, and productivity losses.
- There is an urgent need for cost-effective interventions to alleviate the financial burden on IBD patients and their families.
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 disease features. 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.