Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Abstract

Background. Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD).Aim. To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US).Methods. We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn’s disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures.Results. Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N = 238), $7,827 (N = 95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N = 276, 372, p < 0.05). Publicly insured patients incurred the highest costs ($18,067) over privately insured ($8,014, p < 0.05) or uninsured patients ($5,129, p < 0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p < 0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI [1.08–4.19]) or no insurance (OR 4.94, CI [1.26–19.47]), with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI [0.15–0.95]) and office-based care (OR 0.21, CI [0.07–0.62]).Conclusions. In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.

Anxiety But Not Depression Predicts Poor Outcomes in Inflammatory Bowel Disease

“…Chronic diseases such as IBD lead to a high burden of care for health care systems and for society [15]. Emergency room visits and hospitalizations are two important drivers of direct costs when it comes to cost of care for patients with IBD [16,17].…”

“…SD)16.3). The median HADS anxiety subscore was 7 (interquartile range (IQR) 8) and the median HADS depression subscore was 3 (IQR 6).Table 1details baseline characteristics, which were similar between those who had elevated anxiety and/or depression sub-score at baseline compared with those who did not, with the exception of current smoker status (29.6% among those with elevated anxiety and/or depression sub-score at baseline vs. 14.2% in those without, p=0.0002).…”

Out-of-pocket Cost Burden in Pediatric Inflammatory Bowel Disease

“…True to the Institute of Medicine vision, delivering high-value outpatient IBD management should be the gastroenterologists' utmost goal, providing best care at low costs and minimizing financial stress on families with children affected by IBD. Because anti-TNFs represent the class of drugs most likely associated with deep remission, findings from our study may allude to the rationale for improved outpatient management using earlier adoption of anti-TNFs when necessary 28 – 33 because acute care services are arguably most costly from the patient's perspective.…”

Population Health Management for Inflammatory Bowel Disease

“…Patients at risk can be identified through an evaluation of known principal determinants, drivers, and predictors of IBD health and health care expenditure ( Figure 2). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The greatest degree of variability in care for these patients occurs in diagnosis and management of acute disease flares (delay in initial IBD diagnosis or diagnosis of an acute disease flare due to lack of access or lack of guidelinecongruent care), prevention of complications (inappropriate use of ineffective therapy without adequate risk stratification and prognostication through prediction modeling, delay in use of effective therapy resulting in loss of window of opportunity, fragmentation of health care resulting in inadequate communication, and interruption of therapy), and minimization of treatment-related risks (inadequate understanding of differential risks with therapies promoting inappropriate use). These determinants could serve as triggers for PHM systems to identify subpopulations and health care interactions at greatest need for optimized coordinated care.…”