Demographic and Clinical Predictors of High Healthcare Use in Patients with Inflammatory Bowel Disease

Abstract

Background Inflammatory bowel disease (IBD) is a heterogeneous chronic inflammatory condition requiring significant healthcare expenditure. Subgroups of individuals contribute disproportionately to spending. We aimed to determine demographic and clinical factors predictive of high healthcare expenditures for IBD patients followed over a multiyear period. Methods This was a registry analysis using a prospective observational, consented, natural history registry from a tertiary IBD center and associated medical charges, not including pharmacy expenses. The 100 patients with the highest medical charges (top 5%) were compared to the median 300 patients. Logistic regression determined demographic and clinical factors associated with high charge patients. Results IBD patients in the high charge group had significantly more unemployment (p<0.0001), black race (p=0.013), comorbid psychiatric illness (p=0.002), hypertension (p=0.01), diabetes (p=0.004), opiate use (p<0.0001), perianal involvement (p=0.002), penetrating disease (p<0.0001), and extensive colitis (p=0.01). In multivariate analysis unemployment (CD: OR 3.04; 95% CI 1.32–7.02; UC: OR 2.68; 95% CI 1.20–5.99), psychiatric illness (UC: OR 2.08; 95% CI 1.03–4.19), opiates (CD: OR 5.61; 95% CI 2.67–11.82; UC: OR 5.14; 95% CI 2.52–10.48), prior surgery (CD: OR 3.29; 95% CI 1.59–6.82; UC: OR 2.72; 95% CI 1.39–5.32), penetrating CD (OR 3.29; 95% CI 1.02–10.62), and corticosteroid requirement (CD: OR 3.78; 95% CI 1.86–7.65; UC: OR 2.98; 95% CI 1.51–5.90) remained independently associated with high charges. Conclusion High expenditure IBD patients were affected by more severe disease. The high prevalence of depression, anxiety, and chronic pain in these patients suggests the need for focused treatment of these comorbidities ultimately to reduce financial burden.

The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease

“…17–19 In addition, anxiety has been associated with worse outcomes among pediatric patients with IBD 20 and increased resource utilization among adult patients with IBD. 21,22 Although the impact of these psychological comorbidities has been evaluated in multiple studies, a majority of patients with UC or CD may not receive adequate psychosocial support in the scheme of their overall treatment for IBD. 23 Among patients with CD in our population, a co-existing diagnosis of anxiety or depression was associated with readmission within 90 days in both the unadjusted analysis and adjusted analyses.…”

The Cost of Crohnʼs Disease

“…(10) In our prior five year analysis of 1600 patients with IBD, 54.8% (n=876) of whom had CD, a subset of 9% of patients were found to account for 51.2% of the five year cumulative financial charges for the entire cohort. (17) With the rising cost of healthcare in the US, there is now a mounting interest to identify these high utilizers so that interventions to improve co-ordination of care and preventive care for them maybe tailored and better enforced. (23)…”

“…(14-16) In our previous study additional factors such as black race, use of opiates, penetrating CD phenotype and the use of more aggressive medical therapy at first visit were baseline characteristics that showed association with increased healthcare utilization and expenditure over the next five years. (17) Given the ability of change in LI to delineate distinct CD phenotypes, we aimed to characterize the financial burden from all medical care in a 5-year prospective cohort of CD patients stratified into LI-based disease phenotypes and to evaluate its utility in identifying the subset of costliest patients.…”

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

“…Despite the fact that black patients are suspected to have an overall lower prevalence of IBD in the US, prior studies have suggested that black patients are more likely to experience IBD-related hospitalizations and higher IBD-related mortality when compared to non-Hispanic white and Hispanic populations. 2 Additionally, although black race has been associated with an increased likelihood of significant healthcare expenditures related to IBD, 3 in other evaluations, black patients were less likely to receive therapy with infliximab 4 and thiopurines 5 when compared to white patients. Similarly, Hispanic patients are less likely to receive therapy with biologics and immunomodulators when compared to white patients.…”