Direct Health Care Costs of Crohn's Disease and Ulcerative Colitis in US Children and Adults

Kappelman, Michael D.; Rifas‐Shiman, Sheryl L.; Porter, Carol Q.; Ollendorf, Daniel A.; Sandler, Robert S.; Galanko, Joseph A.; Finkelstein, Jonathan A.

doi:10.1053/j.gastro.2008.09.012

Cited by 580 publications

(446 citation statements)

References 22 publications

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“…Th e direct medical costs alone exceed four billion dollars annually, comprising estimated hospital costs of over US $ 960 million ( 10,11 ) and drug costs of $ 680 million ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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“…Th e direct medical costs alone exceed four billion dollars annually, comprising estimated hospital costs of over US $ 960 million ( 10,11 ) and drug costs of $ 680 million ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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“…In 2008, the direct costs associated with the disease exceeded 6.8 billion dollars (4), and furthermore, the worldwide prevalence of IBD appears to be increasing (5).…”

Section: In the Unitedmentioning

confidence: 99%

Peroxisome Proliferator-activated Receptor-γ Coactivator 1-α (PGC1α) Protects against Experimental Murine Colitis

Cunningham

Vincent

Sodhi

et al. 2016

Journal of Biological Chemistry

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Peroxisome proliferator-activated receptor-␥ coactivator 1-␣ (PGC1␣) is the primary regulator of mitochondrial biogenesis and was recently found to be highly expressed within the intestinal epithelium. PGC1␣ is decreased in the intestinal epithelium of patients with inflammatory bowel disease, but its role in pathogenesis is uncertain. We now hypothesize that PGC1␣ protects against the development of colitis and helps to maintain the integrity of the intestinal barrier. We selectively deleted PGC1␣ from the intestinal epithelium of mice by breeding a PGC1␣ loxP/loxP mouse with a villin-cre mouse. Their progeny (PGC1␣ ⌬IEC mice) were subjected to 2% dextran sodium sulfate (DSS) colitis for 7 days. The SIRT1 agonist SRT1720 was used to enhance PGC1␣ activation in wild-type mice during DSS exposure. Mice lacking PGC1␣ within the intestinal epithelium were more susceptible to DSS colitis than their wild-type littermates. Pharmacologic activation of PGC1␣ successfully ameliorated disease and restored mitochondrial integrity. These findings suggest that a depletion of PGC1␣ in the intestinal epithelium contributes to inflammatory changes through a failure of mitochondrial structure and function as well as a breakdown of the intestinal barrier, which leads to increased bacterial translocation. PGC1␣ induction helps to maintain mitochondrial integrity, enhance intestinal barrier function, and decrease inflammation.

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“…Our annual per capita expenditures of $10,364 for CD and $7,827 for UC are within the range of previously published values of $8,265 and $11,129 for CD, and $5,066 and $7,706 for UC as published by Kappelman and Gunnarsson,respectively. 4,29 Our treated prevalence values, despite missing IBD patients without medical events due to the nature of MEPS data collection, still approximate disease prevalences in literature. 5,30,31 This study's averaging of data over the years from 1996 to 2011 also affects the prevalence values, since prevalence rates have been on a steady rise.…”

Section: Discussionmentioning

confidence: 55%

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

Park

Bhattacharya

Park

2014

Preprint

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View the peer-reviewed version (peerj.com/articles/587), which is the preferred citable publication unless you specifically need to cite this preprint. 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,, 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. Disclosures: Authors report no conflicts of interest as described by PeerJAuthor Contributions: Michelle D Park, BA -obtaining funding source, planning and conducting the study, collecting and interpreting data, and drafting/editing the manuscript. Jay Bhattacharya, MD, PhD -planning the study, interpreting data, and editing the manuscript. KT Park, MD, MS -obtaining funding source, planning and conducting the study, collecting and interpreting data, and drafting/editing the manuscript. 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,, with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-b...

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Direct Health Care Costs of Crohn's Disease and Ulcerative Colitis in US Children and Adults

Abstract: Background-Data regarding the health care costs of inflammatory bowel disease (IBD) in the United States are limited.

Cited by 580 publications

References 22 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Peroxisome Proliferator-activated Receptor-γ Coactivator 1-α (PGC1α) Protects against Experimental Murine Colitis

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

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