Healthcare resource utilization and cost trends in pediatric inflammatory bowel disease within an accountable care
Peter F Farmer1, Huey-Fen Chen2, Jennifer Cooper2,3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Healthcare costs for pediatric inflammatory bowel disease (IBD) are rising. IBD infusions drive utilization and expenses, but biosimilars show promise for reducing these costs in children and adolescents.
Area of Science:
- Pediatric gastroenterology
- Health services research
- Healthcare economics
Background:
- National healthcare utilization and costs for inflammatory bowel disease (IBD) are increasing.
- Pediatric IBD populations represent a significant and growing healthcare burden.
Purpose of the Study:
- To analyze healthcare utilization and cost trends in pediatric patients with IBD.
- To examine these trends within a pediatric Medicaid accountable care organization (ACO).
Main Methods:
- Cross-sectional analysis of inpatient and outpatient insurance claims from 269 pediatric IBD patients (October 2015 - December 2020).
- Assessment of healthcare utilization and costs per encounter type annually.
- Evaluation of emergency department (ED), gastrointestinal surgical, and IBD-related infusion encounters.
Main Results:
- Total encounters and costs remained stable, with a decrease in 2020 likely due to the COVID-19 pandemic.
- Outpatient encounters consistently represented over 94% of all encounters.
- Costs for IBD-related infusions significantly increased, accounting for 60% of total claims costs by 2020, despite a rise in biosimilar use.
Conclusions:
- IBD-related infusion encounters are the primary drivers of healthcare utilization and costs in pediatric IBD.
- Increased use of biosimilars presents a significant opportunity to reduce healthcare expenditures in this population.
- Findings align with trends observed in adult IBD populations.
Objective:
Healthcare utilization and costs for the inflammatory bowel disease (IBD) population continue to rise nationally. We aimed to describe healthcare utilization and cost trends in children and adolescents with IBD within a pediatric Medicaid accountable care organization (ACO).
Methods:
Cross-sectional analysis of inpatient and outpatient insurance claims of known patients with IBD at a single center, also enrolled in a regional ACO. Healthcare utilization and costs were assessed by the total number of different types of healthcare encounters and associated claims on a per-year basis.
Results:
We used data from claims incurred by 269 unique patients between October 2015 and December 2020. Total encounters and costs remained stable apart from a notable decrease in encounters in 2020 (likely related to the COVID-19 pandemic). Proportion of outpatient and inpatient encounter types remained stable, with greater than 94% of encounters being outpatient and 1%-2% inpatient. emergency department (ED) encounters decreased significantly from 141 total ED encounters (5% of encounters) in 2016 to 66 (3%) in 2020. Gastrointestinal surgical encounters remained consistent; however, the costs associated more than doubled from $189,970 (8%) in 2016 to $404,793 (19%) in 2020. Total costs from IBD-related infusion encounters increased from $693,440 (29% of total claims costs) in 2016, to $1,241,089 (60%) in 2020 (p < 0.001). Biosimilar use increased rapidly during our study period with a relative decrease in IBD-related infusion costs.
Conclusions:
Consistent with adult data, IBD-related infusion encounters are a primary driver of healthcare utilization and cost in pediatric IBD. Biosimilars offer an opportunity to decrease these costs.
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