Trends and Factors Affecting Hospitalization Costs in Patients with Inflammatory Bowel Disease: A Two-Center Study over the Past Decade

Abstract

With the growing number of patients with inflammatory bowel disease (IBD) and hospitalization cases, the overall medical care cost elevates significantly in consequence. A total of 2458 hospitalizations, involving 1401 patients with IBD, were included from two large medical centers. Hospitalization costs and factors impacting cost changes were determined. Patients with IBD and frequency of hospitalizations increased significantly from 2003 to 2011 (P < 0.001). The annual hospitalization cost per patient, cost per hospitalization, and daily cost during hospitalization increased significantly in the past decade (all P < 0.001). However, length of stay decreased significantly (P < 0.001). Infliximab was the most significant factor associated with higher hospitalization cost (OR = 44380.09, P < 0.001). Length of stay (OR = 1.29, P < 0.001), no medical insurance (OR = 1.31, P = 0.017), CD (OR = 3.55, P < 0.001), inflammatory bowel disease unclassified (IBDU) (OR = 4.30, P < 0.0001), poor prognosis (OR = 6.78, P < 0.001), surgery (OR = 3.16, P < 0.001), and endoscopy (OR = 2.44, P < 0.001) were found to be predictors of higher hospitalization costs. Patients with IBD and frequency of hospitalizations increased over the past decade. CD patients displayed a special one peak for age at diagnosis, which was different from UC patients. The increased hospitalization costs of IBD patients may be associated with infliximab, length of stay, medical insurance, subtypes of IBD, prognosis, surgery, and endoscopy.

Figure 1

Growing population of IBD patients and hospitalizations. (a) Number of newly diagnosed patients with IBD per year. CD patients increased more significantly (R ² = 0.916, P < 0.001); (b) number of hospitalizations per year, number of hospitalizations increased more significantly in CD patients (R ² = 0.937, P < 0.001); (c) proportion of each subtype of IBD changed from 2003 to 2011. Population data of IBD patients and hospitalizations were collected from Renji hospital between Jan, 2003 and Dec, 2011 and from Ruijin hospital between Jan, 2010 and Dec, 2011. Proportion data of IBD patients were collected from Renji hospital between Jan, 2003 and May, 2012 and Ruijin hospital from Aug, 2009 and Jun, 2012. (d) The trend of length of stay.

Figure 2

Age distribution of UC (a) and CD patients (b) for their first hospitalization.

Figure 3

Alterations of hospitalization costs. (a) The variation trend of annual total hospitalization cost for IBD treatment from 2003 to 2011; (b) linear regression line of annual hospitalization cost per CD patient and exponential regression curve of annual hospitalization cost per UC patient from 2003 to 2011; (c) linear regression line of the cost per CD hospitalization and exponential regression curve of the cost per UC hospitalization from 2003 to 2012; (d) daily hospitalization cost.

Figure 4

Medication and infliximab costs in IBD. (a) The medication cost per hospitalization; (b) the proportion of medication in total hospitalization cost; (c) the population of patients treated with infliximab and the number of hospitalizations with infliximab infusion.

Figure 5

Cost of examinations. (a) Cost of examinations; (b) the proportion of examination in total hospitalization cost.

Figure 6

Endoscopies used in IBD determination or evaluation. (a) Percentage of hospitalizations with endoscopy conducted in different subtypes of IBD; (b) the proportion of different endoscopies; (c) the proportion of endoscopic costs; (d) endoscopic costs per hospitalization of different subtypes of IBD.

Figure 7

Surgery and costs in IBD. (a) Surgical rates in hospitalizations of IBD; (b) surgical rates changed in the last decade; (c) the costs were significantly higher in hospitalizations with surgery than in hospitalizations without surgery.