Improved Healthcare Access Reduces Requirements for Surgery in Indigent IBD Patients Using Biologic Therapy: A...

Area of Science:

• Gastroenterology
• Health Services Research
• Health Economics

Background:

• Low socioeconomic status (SES) is linked to increased morbidity and healthcare resource utilization (HRU) in inflammatory bowel disease (IBD).
• Financial assistance programs (FAP) aim to mitigate these disparities by improving healthcare access for indigent patients.

Purpose of the Study:

• To evaluate the impact of a FAP on clinical outcomes and HRU in indigent IBD patients initiating biologic therapy.
• To identify potential disparities in IBD care related to financial assistance.

Main Methods:

• Retrospective cohort study of 204 indigent IBD patients (>18 years) at a safety-net hospital initiating biologics (2010-2019).
• Patients were stratified by FAP status versus those with insurance (Medicare, Medicaid, commercial).
• Outcomes included steroid-free remission, surgery, hospitalization, and ED utilization, analyzed using multivariable logistic regression and decision tree analysis (DTA).

Main Results:

• FAP patients presented with less complex Crohn's disease and fewer prior surgeries compared to non-FAP patients.
• No significant differences were observed in remission rates or time to biologic receipt.
• FAP enrollment was independently associated with a reduced likelihood of undergoing surgery (OR: 0.28, 95% CI [0.08−0.91]).

Conclusions:

• FAP enrollment in indigent IBD patients requiring biologics is associated with a significant reduction in surgical interventions.
• Further research is warranted to elucidate mechanisms behind surgical differences and develop interventions addressing healthcare disparities in IBD.