Epidemiology and the cost burden of hospitalized pediatric-onset inflammatory bowel disease in China: A national
Xiaolu Nie1, Jing Li2, Hui Xu3
1Center for Clinical Epidemiology and Evidence-based Medicine Beijing Children's Hospital, Capital Medical University, National Center for Children's Health Beijing China.
Insights
Hospitalizations for pediatric inflammatory bowel disease (PIBD) in China are rising, especially for Crohn's disease (CD). The cost burden has declined since 2020, but further policy interventions are needed.
Area of Science:
- Gastroenterology
- Pediatrics
- Health Economics
Background:
- Pediatric-onset inflammatory bowel disease (PIBD) and very early-onset IBD (VEO-IBD) require understanding of their epidemiology and economic impact.
- This is crucial for pathogenesis research and informing medical insurance policies.
Purpose of the Study:
- To assess the epidemiology and cost burden of hospitalized PIBD and VEO-IBD in China.
- To compare clinical characteristics and costs among Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) in pediatric patients.
Main Methods:
- A multicenter retrospective study analyzed data from 5230 hospitalized PIBD patients (aged 0-18) in China (2016-2021).
- Sociodemographic and clinical data, length of stay (LOS), and hospitalization expenses were evaluated.
- Cost burden was calculated as out-of-pocket expenditure relative to household income.
Main Results:
- Hospitalizations for PIBD, particularly CD, showed a significant annual increase.
- CD patients were older on average than IBD-unclassified patients, and had shorter LOS.
- While VEO-CD hospitalizations rose, VEO-UC hospitalizations declined; overall cost burden decreased after 2020.
Conclusions:
- The study highlights increasing PIBD hospitalizations in China, with notable trends in CD and age groups.
- Findings provide insights into clinical characteristics and cost burden, informing healthcare policy.
- Recommendations include developing guidelines and health insurance policies to mitigate the financial impact on families.
Importance:
Understanding the epidemiology and cost burden of pediatric-onset inflammatory bowel disease (PIBD) is crucial for shedding light on its pathogenesis and making medical insurance decisions, particularly for very early-onset IBD (VEO-IBD).
Objective:
To assess the epidemiology and cost burden of hospitalized PIBD and VEO-IBD.
Methods:
A multicenter study identified hospitalized PIBD patients aged 0-18 years using the FUTang Updating medical REcords database from 28 hospitals in mainland China (2016-2021). Sociodemographic, clinical characteristics, length of stay (LOS), and expense data were analyzed. The cost burden was evaluated by dividing annual out-of-pocket expenditure by household disposable income. Clinical epidemiology and cost burden were compared between Crohn's disease (CD), ulcerative colitis (UC), IBD-unclassified (IBD-U), and different age groups.
Results:
A total of 5230 hospitalized cases of PIBD were identified. Mean ages for CD (11.8 ± 3.9 years) and UC (8.0 ± 5.2 years) were significantly higher than those of patients with IBD-U (4.5 ± 4.1 years). Hospitalizations for CD showed a notable annual increase. Patients with CD had a shorter LOS (median 3 days) than those with UC (median 6 days) and IBD-U (median 7 days). The number of VEO-CD hospitalizations increased, while that of VEO-UC declined (2016-2021). The median total hospitalization expenses were $1006.7 for CD and $841.6 for UC. The average proportion of annual cost burden of IBD for each PIBD patient from 2016 to 2021 was 16.47%, 14.34%, 20.55%, 18.45%, 12.13%, and 11.16%, respectively, which has declined significantly since 2020.
Interpretation:
This study provides insight into the clinical characteristics and cost burden of PIBD and VEO-IBD in China. Hospitalizations for PIBD, particularly for CD, are increasing. Guidelines and health insurance policies can help mitigate this cost burden.
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