Performance of Novel Inflammatory Bowel Disease-Specific Models for Risk Adjustment.

Area of Science:

• Health Economics
• Clinical Informatics
• Gastroenterology

Background:

• Inflammatory Bowel Disease (IBD) poses significant healthcare costs.
• Accurate risk-adjustment models are crucial for resource allocation and cost prediction in IBD management.
• Existing models may not fully capture the complexities of IBD-related expenditures.

Purpose of the Study:

• To develop and evaluate novel actuarial risk-adjustment models specifically for Inflammatory Bowel Disease (IBD).
• To assess the predictive accuracy of these models for both concurrent and prospective IBD-related costs.
• To determine the utility of administrative claims data in constructing these models.

Main Methods:

• Retrospective, cross-sectional study utilizing administrative claims data from 2020-2022.
• Development of clinical-risk groupers for Crohn's disease and ulcerative colitis based on IBD costs.
• Application of linear regression models to assess relationships between risk groupers and costs, with separate analyses for insurance types and therapy usage.

Main Results:

• Clinical-risk groupers explained varying percentages of concurrent cost variance (2.01%-20.99%) across patient groups.
• Inclusion of IBD-related hospitalizations significantly improved concurrent cost prediction (R² up to 41.56%).
• Prospective models showed moderate predictive power, with no additional predictors enhancing performance.

Conclusions:

• Novel concurrent and prospective risk-adjustment models for IBD patients were successfully developed.
• These models effectively explain and predict IBD-related costs using administrative claims data.
• The developed models demonstrate potential real-world utility in diverse healthcare settings for IBD cost management.