Health care resource utilization in inflammatory bowel disease

Abstract

Background & aims: The aim of this study was to quantify temporal changes in health care utilization by a population-based cohort of IBD.

Methods: By using the University of Manitoba IBD Epidemiology Database we assessed utilization of outpatient and hospital services, estimating relative risk (RR) of utilization for IBD cases compared with a matched cohort of non-IBD controls and for CD versus UC. We tested differences in utilization between prevalence cohorts 1990-1991 and 2000-2001. Also, utilization of the 1987-1988 incidence cohort was followed forward 15 years from diagnosis. The probability, intensity, and volume of utilization were estimated.

Results: In 2000-2001, IBD patients compared with controls were more likely to have an outpatient visit (RR, 1.18; 95% confidence interval [CI], 1.17-1.19) and an overnight hospital stay (RR, 2.32; 95% CI, 2.16-2.49). CD cases were more likely than UC cases to be hospitalized (RR, 1.26; 95% CI, 1.11-1.43) and had a greater number of outpatient visits. From 1990-1991 to 2000-2001, IBD cases experienced a significant decrease in the likelihood of an outpatient surgical visit relative to non-IBD controls (P < .05), and for those cases who were hospitalized, CD cases tended to be less likely than UC cases to experience IBD-specific inpatient surgery (P < .07). Of the 1987-1988 incidence cohort, 80% of admissions that occurred during the follow-up period were during the first 5 years after diagnosis.

Conclusions: In 2000-2001, health care utilization continued to be higher in IBD versus controls and CD versus UC; however, the gap in costly service utilization appeared to narrow between the latter pair.