Systematic analysis of therapeutic patterns and healthcare use during 12 months before inflammatory bowel disease-related hospitalization in Switzerland

Abstract

BACKGROUND AND AIMS Given the lack of data, we aimed to systematically analyze therapeutic patterns and health resource utilization in the year before inflammatory bowel disease (IBD)related hospitalization. METHODS Based on claims data of the Helsana health insurance group, therapy patterns and health resource utilization were assessed, and costs reimbursed by mandatory basic health insurance were calculated during a one-year period before an index hospitalization between 1 January 2013 to 31 December 2015. RESULTS We analyzed 344 IBD patients (140 ulcerative colitis [40.7%], 204 Crohn's disease [59.3%]). Drug regimens applied in the year before index hospitalization were as follows: no IBD drugs (43.6% ulcerative colitis, 43.1% Crohn's disease); 5-ASA (45.7% ulcerative colitis, 19.1% Crohn's disease); local steroids (17.9% ulcerative colitis, 17.6% Crohn's disease); systemic steroids (38.6% ulcerative colitis, 29.4% Crohn's disease); immunomodulators (10.7% ulcerative colitis, 18.1% Crohn's disease); biologics (10% ulcerative colitis, 24% Crohn's disease); and calcineurin inhibitors (2.1% ulcerative colitis, 1.5% Crohn's disease). Forty-five percent of ulcerative colitis patients and 31.4% of Crohn's disease patients had no diagnostic procedures [computed tomography (CT), MRI, radiograph, sonography, colonoscopy, and calprotectin] in the year before hospitalization. Total annual health care costs before index hospitalization was EUR 4060 (interquartile range (IQR) 2360-7390) for ulcerative colitis and EUR 4900 (IQR 1520-14 880) for Crohn's disease patients, respectively. CONCLUSIONS Over 40% of ulcerative colitis and Crohn's disease patients did not receive any treatment in the year before index hospitalization. Efforts should be launched to timely diagnose and adequately treat IBD outpatients.

Clinical procedures used to diagnose inflammatory bowel disease: real-world evidence from a Danish nationwide population-based study

“…Among patients who underwent at least one procedure, 53% did not undergo diagnostic procedures during the period before their first IBD hospital admission (figure 3). This is compatible with the finding that 37% of patients with IBD had no diagnostic procedures in the year before hospitalisation 14. Some patients might have been asymptomatic until the IBD diagnosis was given at a hospitalisation with acute symptoms.…”

“…This is compatible with the finding that 37% of patients with IBD had no diagnostic procedures in the year before hospitalisation. 14 Some patients might have been asymptomatic until the IBD diagnosis was given at a hospitalisation with acute symptoms. Other cases may be explained by mild symptoms and a wait-and-see approach as described previously.…”

“…Open access investigated procedures involved in establishing an IBD diagnosis, [14][15][16][17][18][19] which, however, is important to identify shortcomings and areas for potential improvement. The Danish nationwide health registers provide a unique opportunity for such a study.…”

“…The diagnostic work-up is complex without a commonly accepted ‘gold standard’ and may vary in clinical practice. Only a few studies have investigated procedures involved in establishing an IBD diagnosis,14–19 which, however, is important to identify shortcomings and areas for potential improvement. The Danish nationwide health registers provide a unique opportunity for such a study.…”