The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn's & Colitis Foundation

Abstract

Background: The Crohn's & Colitis Foundation's Cost of Inflammatory Bowel Disease (IBD) Care Initiative seeks to quantify the wide-ranging health care costs affecting patients living with IBD. We aimed to (1) describe the annualized direct and indirect costs of care for patients with Crohn's disease (CD) or ulcerative colitis (UC), (2) determine the longitudinal drivers of these costs, and (3) characterize the cost of care for newly diagnosed patients.

Methods: We analyzed the Optum Research Database from the years 2007 to 2016, representing commercially insured and Medicare Advantage-insured patients in the United States. Inclusion for the study was limited to those who had continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months before through 12 months after the index date of diagnosis). The value of patient time spent on health care was calculated as number of workplace hours lost due to health care encounters multiplied by the patients' estimated average wage derived from the Bureau of Labor Statistics. Comparisons between IBD patients and non-IBD patients were analyzed based on demographics, health plan type, and length of follow-up. We used generalized linear models to estimate the association between total annual costs and various patient variables.

Results: There were 52,782 IBD patients (29,062 UC; 23,720 CD) included in the analysis (54.1% females). On a per-annual basis, patients with IBD incurred a greater than 3-fold higher direct cost of care compared with non-IBD controls ($22,987 vs $6956 per-member per-year paid claims) and more than twice the out-of-pocket costs ($2213 vs $979 per-year reported costs), with all-cause IBD costs rising after 2013. Patients with IBD also experienced significantly higher costs associated with time spent on health care as compared with controls. The burden of costs was most notable in the first year after initial IBD diagnosis (mean = $26,555). The study identified several key drivers of cost for IBD patients: treatment with specific therapeutics (biologics, opioids, or steroids); ED use; and health care services associated with relapsing disease, anemia, or mental health comorbidity.

Conclusion: The costs of care for IBD have increased in the last 5 years and are driven by specific therapeutics and disease features. In addition, compared with non-IBD controls, IBD patients are increasingly incurring higher costs associated with health care utilization, out-of-pocket expenditures, and workplace productivity losses. There is a pressing need for cost-effective strategies to address these burdens on patients and families affected by IBD.

Keywords: Costs of care; Crohn’s disease; anemia; biologics; direct costs; emergency room use; indirect costs; inflammatory bowel diseases; mental health; narcotics; opioids; steroids; ulcerative colitis.

FIGURE 1.

Cost of IBD care cohort identification flow diagram.

FIGURE 2.

A, Total direct annual costs per patient (PMPY) (IBD and non-IBD Controls). B, Total estimated out-of-pocket annual costs per patient (PMPY) (IBD and non-IBD Controls). C, Total annual estimated lost wages per patient (PMPY) (IBD and non-IBD Controls). Abbreviations: BLS = United States Bureau of Labor Statistics

FIGURE 3.

Longitudinal trends in all-cause costs of IBD.

FIGURE 4.

Adjusted cost ratio comparison by age.

FIGURE 5.

Cost of New diagnosis of IBD compared with non-IBD controls.

FIGURE 6.

Drivers of IBD costs of care.

FIGURE 7.

Cost ratios of pharmacotherapy for IBD patients. Cost ratios from generalized linear models, with ratio of cost for patients treated with the medication vs untreated with that medication in each calendar year. P < 0.05 for main effects for medications, calendar year (vs 2007) and for medicationXyear interaction term.