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A Phenome-Wide Analysis of Healthcare Costs Associated with Inflammatory Bowel Diseases
Winston Cai1, Andrew Cagan2, Zeling He3
1Bronx Science, New York City, NY, USA.
Insights
Inflammatory bowel disease (IBD) healthcare costs are significantly driven by complications like intestinal obstruction and fluid-electrolyte imbalances. Active disease and bowel damage are key cost predictors.
Area of Science:
- Gastroenterology
- Health Economics
- Computational Biology
Background:
- Crohn's disease (CD) and ulcerative colitis (UC), forms of inflammatory bowel disease (IBD), incur substantial direct healthcare costs.
- Comprehensive analyses linking IBD and non-IBD comorbidities to direct costs in this patient population are limited.
Purpose of the Study:
- To identify predictors of high direct healthcare costs in patients with IBD.
- To analyze the association between specific comorbidities and overall healthcare expenditures in IBD patients.
Main Methods:
- Utilized a validated cohort of 10,721 IBD patients (50% with CD).
- Calculated total healthcare costs from hospitalizations, surgeries, imaging, outpatient visits, endoscopic evaluations, and ER care.
- Performed phenome-wide association analysis (PheWAS) on ICD-9 codes to identify cost predictors.
Main Results:
- Median total cost per patient was $11,203.
- Intestinal obstruction (without hernia) and other intestinal obstructions were strongly associated with costs (p < 10^-130).
- Fluid-electrolyte imbalance, hypovolemia, abdominal pain, and anemia also showed significant cost associations. Psychological comorbidities were linked to higher ER costs.
Conclusions:
- Markers of irreversible bowel damage and active disease significantly influence IBD-related healthcare costs.
- Comorbidities, including cardiopulmonary and psychological conditions, contribute to the overall cost burden.
Introduction:
Crohn's disease (CD) and ulcerative colitis (UC) are associated with considerable direct healthcare costs. There have been few comprehensive analyses of all IBD- and non-IBD comorbidities that determine direct costs in this population.
Methods:
We used data from a validated cohort of patients with inflammatory bowel disease (IBD). Total healthcare costs were estimated as a sum of costs associated with IBD-related hospitalizations and surgery, imaging (CT or MR scans), outpatient visits, endoscopic evaluation, and emergency room (ER) care. All ICD-9 codes were extracted for each patient and clustered into 1804 distinct phecode clusters representing individual phenotypes. A phenome-wide association analysis (PheWAS) was performed using logistic regression to identify predictors of being in the top decile of costs.
Results:
Our cohort is comprised of 10,721 patients with IBD among whom 50% had CD. The median age was 46 years. The median total cost per patient is $11,203 (IQR $2396-30,563). The strongest association with total healthcare costs was intestinal obstruction without mention of hernia (p = 5.93 × 10-156) and other intestinal obstruction (p = 9.24 × 10-131). In addition, strong associations were observed for symptoms consistent with severity of IBD including the presence of fluid-electrolyte imbalance (p = 1.90 × 10-130), hypovolemia (p = 1.65 × 10-114), abdominal pain (p = 7.29 × 10-60), and anemia (p = 1.90-10-83). Cardiopulmonary diseases and psychological comorbidity also demonstrated significant associations with total costs with the latter being more strongly associated with ER visit-related costs.
Conclusions:
Surrogate markers suggesting possible irreversible bowel damage and active disease demonstrate the greatest influence on IBD-related healthcare costs.
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