Health Care Cost for Children Newly Diagnosed With Inflammatory Bowel Disease

Abstract

Background The increasing incidence of pediatric inflammatory bowel disease (IBD), along with more extensive and severe disease in children, raises concern for related health care expenditures. Aim The aim of this study was to quantify and characterize costs of pediatric IBD in the year following diagnosis. Methods We identified all patients diagnosed with IBD at Connecticut Children’s Medical Center in 2016 with a minimum of 1 year follow-up. Clinical and demographic factors were recorded at diagnosis. We examined paid service and professional costs related to outpatient medications and infusions, outpatient procedures and radiology imaging, inpatient services, and outpatient visits. Actual dollar reimbursements were from private and public payers. Data is reported as mean ± SD and median (IQR). Results First-year cost data were collected on 67 patients (43 Crohn’s disease [CD], 24 ulcerative colitis [UC], mean age 13 years [SD 3.22]) revealing a mean cost of $45,753 (SD $37,938), with $43,095 (SD $30,828) for CD and $50,516 (SD $48,557) for UC. Severe CD (n = 11) had a mean cost of $71,176 (SD $43,817) and severe UC (n = 5) $134,178 (SD $40,920). Patients receiving infusion therapy had a mean cost of $59,376 (SD $38,724) compared with $27,903 (SD $28,795) for those not receiving infusions. Overall cost distribution showed 37% from infusion costs, 25% hospital costs, 18% outpatient procedures, 10% outpatient oral medications, 7% outpatient imaging, and 3% outpatient visits. Conclusions Infusion therapy is a key driver of first-year costs for children newly diagnosed with IBD. Understanding cost distribution in relation to disease presentation can be helpful to anticipate future related costs.

Trends in paediatric inflammatory bowel disease‐attributable direct costs: a population‐based analysis

“…In addition, utilisation of anti‐TNF medications was the main costs driver, accounting for 64% and 31% of the total cost of CD and UC, respectively 16 . Fondell et al 17 examined direct costs in a small cohort of children recently diagnosed with IBD in the year following the diagnosis. Despite early disease course, infusion costs comprised 37% of all direct costs, indicating an early introduction of biologics.…”

Applying Telemedicine to Multidisciplinary Pediatric Inflammatory Bowel Disease Care

“…An aim of its application was to decrease the financial burden of IBD care; adults with IBD have annual out of pocket costs greater than two times those of adults without IBD, and costs due to missed work outweigh out of pocket costs [ 16 ]. Concerningly, medical costs associated with pediatric IBD are predicted to be higher than those with adult-onset disease [ 17 , 18 , 19 ], and data are limited regarding financial and time costs for their parents due to missed work.…”

Crohn disease

“…Fondell et al found that infusion therapy is a driving cost for newly diagnosed cases, followed by hospitalization and outpatient procedures, oral medications, imaging, and visits. 11 In addition to high medical management costs, patients also endure the psychological impacts of the disease on quality of life. Depression and anxiety associated with the condition can perpetuate lower adherence to medical regimens and increased cost of care.…”

“…In the subgroup who underwent a CD-related surgery, cost per patient/year reached $101,013, likely in part due to procedures such as intestinal resection, colostomies, endoscopic balloon dilation, and stricturoplasty. Fondell et al found that infusion therapy is a driving cost for newly diagnosed cases, followed by hospitalization and outpatient procedures, oral medications, imaging, and visits 11. In addition to high medical management costs, patients also endure the psychological impacts of the disease on quality of life.…”