Factors That Predict High Health Care Utilization and Costs for Patients With Inflammatory Bowel Diseases

Abstract

BACKGROUND & AIMS A subset of patients with inflammatory bowel diseases (IBD) have continuously active inflammation, leading to a high number of complications and high direct health care costs (diagnostic tests, medications, and surgeries) and indirect costs (reduced employment and productivity and fewer opportunities for activities). Identifying these high-risk patients and providing effective interventions could produce better outcomes and reduce costs. We used prior year data to create IBD risk models to predict IBD-related hospitalizations, emergency department visits, and high treatment charges (>$30,000/year) in the subsequent year. METHODS We performed a retrospective study of medical records from all patients with IBD treated at the University of Michigan Hospital from fiscal years 2013–2015. We selected clinical variables from the prior year and tested their abilities to predict 3 adverse outcomes (IBD-related hospitalizations, emergency department visits, and treatment charges >$30,000/year) in the subsequent year. Individual patients were only included once in the data set. We created a multivariate model that was based on a 70% randomly selected cohort (1005 patients) and validated the model on the other 30% (425 patients). Logistic regression was used for bivariate and multivariate analyses. RESULTS Factors that predicted high-cost outcomes included the presence of psychiatric illness, use of corticosteroids, use of narcotics, low levels of hemoglobin, and high numbers of IBD-related hospitalizations. In the validation cohort, the model predicted IBD-related hospitalizations, emergency department visits, and high charges in the following year with receiver operating characteristic curve values of 0.751, 0.738, and 0.744, respectively. CONCLUSIONS We identified 5 factors that can effectively identify patients with IBD at high risk for hospitalization, emergency department visits, and high treatment charges in the next year. These patients should be closely monitored and aggressively managed.

Reduced Unplanned Care and Disease Activity and Increased Quality of Life After Patient Enrollment in an Inflammatory Bowel Disease Medical Home

“…These findings corroborate previous results from our group as well as others. 15–18 Anxiety and depression rates were comparable to published rates. 19, 20 Psychosocial complexity influenced the IBD course.…”

Review article: nonclinical and clinical pharmacology, pharmacokinetics and pharmacodynamics of etrolizumab, an anti‐β7 integrin therapy for inflammatory bowel disease

“…However, approximately 10%‐30% of IBD patients are primary nonresponders to anti‐TNF‐α therapy, and another approximately 20%‐40% of IBD patients stop responding to anti‐TNF‐α therapy over time . In addition, these TNF‐α inhibitors are associated with increased risk of infections and IBD‐related complications stemming from inadequate disease control . In addition to offering better benefit‐risk profiles, new innovative and effective therapies will also positively influence the balance of cost‐effectiveness by lowering healthcare utilisation, given that IBD was the primary cause for 1.36 and 1.9 million physician visits per year in the United States in 2004 and 2009, respectively, and the first‐listed discharge diagnosis in over 100 000 hospitalisations .…”

“…8,9 In addition, these TNF-a inhibitors are associated with increased risk of infections and IBD-related complications stemming from inadequate disease control. [10][11][12] In addition to offering better benefit-risk profiles, new innovative and effective therapies will also positively influence the balance of cost-effectiveness by lowering healthcare utilisation, given that IBD was the primary cause for 1.36 and 1.9 million physician visits per year in the United States in 2004 and 2009, respectively, and the first-listed discharge diagnosis in over 100 000 hospitalisations. 13 Hence, there continues to be a need for novel treatments with improved benefit-risk profiles that enhance the long-term prognosis of patients with IBD.…”

Does disease activity explain psychological differences in Inflammatory Bowel Disease?

“…Psychiatric distress is a predictor of higher medical resource utilization and costs in inflammatory bowel disease (IBD). 1 Targeting symptoms of anxiety and depression (A&D) may improve clinical outcomes. 2 Association between A&D and clinical recurrence was previously demonstrated.…”