The Cost of Crohnʼs Disease

Rao, Bhavana Bhagya; Click, Benjamin; Koutroubakis, Ioannis Ε.; Rivers, Claudia Ramos; Regueiro, Miguel; Swoger, Jason M.; Schwartz, Marc; Hashash, Jana G.; Barrie, Arthur; Dunn, Michael A.; Binion, David G.

doi:10.1097/mib.0000000000000977

Cited by 28 publications

(12 citation statements)

References 24 publications

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“…Previous studies estimate the annual cost of CD to be between $18,637 and $24,000 8,43. A recent study by Rao et al in published 2017 determined the interquartile range of cost at even between $9128 to $48,079 4. That our results, determined independently of any claims database data, are in line with cost data from claims databases lends further support to our findings.…”

Section: Discussionsupporting

confidence: 90%

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<p>Evaluating the clinical and economic consequences of using video capsule endoscopy to monitor Crohn’s disease</p>

Saunders¹,

Torres²,

Konsinski³

2019

CEG

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Background To assess the cost and patient impact of using small bowel and colon video capsule endoscopy (SBC) for scheduled monitoring of Crohn’s disease (CD). Methods An individual-patient, decision-analytic model of the CD care pathway was developed given current practice and expert input. A literature review informed clinical endpoints with data from peer-reviewed literature. Four thousand simulated CD patients were extrapolated from summary patient data from the Project Sonar Database. Two monitoring scenarios were assessed in this population. The first scenario represented common monitoring practice (CMP) for CD (ileocolonoscopy plus imaging), while in the second scenario patients were converted to disease monitoring using SBC. The cost-effectiveness of using SBC was assessed over 20 years. The cost of switching 50% of patients to SBC was assessed over 5 years for a health-plan including 12,000 patients with CD. Uncertainty of results was assessed using probabilistic sensitivity analysis. Results All patient groups showed increased quality of life with SBC versus CMP, with the highest gain in active symptomatic patients. Over 20 years, SBC reduced costs ($313,367 versus $320,015), increased life expectancy (18.15 versus 17.9 years) and increased quality of life (8.7 versus 8.0 QALY), making it a cost-effective option. SBC was cost-effective in 71% of individuals and 78% of populations including 50 patients. A payer implementing SBC in 50% of patients over 5 years could expect a decreased cost of monitoring (–$469 mean per patient) and surgery (–$698), but increased costs for active treatments (+$717). The discounted mean annual cost of care using CMP was $22,681 per patient over 5 years. The annual savings were $1135 per SBC-patient. The total savings for the payer over 5 years were $36.5 million. Conclusion SBC is likely to be a cost-effective and cost-saving strategy for monitoring CD in the US.

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Section: Discussionsupporting

confidence: 90%

“…The economic burden of CD is also high 3. Median (interquartile) cost of care over 5 years has been reported at $116,838 ($45,643 to $240,398) 4Figure 1Comparison of major surgical outcomes between the model and published literature on Crohn’s disease.…”

Section: Introductionmentioning

confidence: 99%

<p>Evaluating the clinical and economic consequences of using video capsule endoscopy to monitor Crohn’s disease</p>

Saunders¹,

Torres²,

Konsinski³

2019

CEG

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“…In today’s era of effective but costly pharmacotherapies, one driver of the cost of care for patients with IBD appeared to be in outpatient pharmacy utilization. Based on preliminary data here and in other research, 10 , 18 , 19 supported by the overall cost trends in prescription drugs in the United States, 20 , 21 the Foundation identified the cost of biologics as a key strategic area for improved cost-effectiveness, patient advocacy, and patient-centeredness. Facilitating better access to appropriate medications and minimizing transference of drug costs from payers to patients are 2 integral components of improved patient-centered care as identified by the IBD Cost of Care Task Force.…”

Section: Discussionmentioning

confidence: 80%

The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn’s & Colitis Foundation

Park

Ehrlich

Allen

et al. 2019

Inflammatory Bowel Diseases

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321

189

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Background The Crohn’s & Colitis Foundation’s Cost of Inflammatory Bowel Disease (IBD) Care Initiative seeks to quantify the wide-ranging health care costs affecting patients living with IBD. We aimed to (1) describe the annualized direct and indirect costs of care for patients with Crohn’s disease (CD) or ulcerative colitis (UC), (2) determine the longitudinal drivers of these costs, and (3) characterize the cost of care for newly diagnosed patients. Methods We analyzed the Optum Research Database from the years 2007 to 2016, representing commercially insured and Medicare Advantage–insured patients in the United States. Inclusion for the study was limited to those who had continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months before through 12 months after the index date of diagnosis). The value of patient time spent on health care was calculated as number of workplace hours lost due to health care encounters multiplied by the patients’ estimated average wage derived from the Bureau of Labor Statistics. Comparisons between IBD patients and non-IBD patients were analyzed based on demographics, health plan type, and length of follow-up. We used generalized linear models to estimate the association between total annual costs and various patient variables. Results There were 52,782 IBD patients (29,062 UC; 23,720 CD) included in the analysis (54.1% females). On a per-annual basis, patients with IBD incurred a greater than 3-fold higher direct cost of care compared with non-IBD controls ($22,987 vs $6956 per-member per-year paid claims) and more than twice the out-of-pocket costs ($2213 vs $979 per-year reported costs), with all-cause IBD costs rising after 2013. Patients with IBD also experienced significantly higher costs associated with time spent on health care as compared with controls. The burden of costs was most notable in the first year after initial IBD diagnosis (mean = $26,555). The study identified several key drivers of cost for IBD patients: treatment with specific therapeutics (biologics, opioids, or steroids); ED use; and health care services associated with relapsing disease, anemia, or mental health comorbidity. Conclusion The costs of care for IBD have increased in the last 5 years and are driven by specific therapeutics and disease features. In addition, compared with non-IBD controls, IBD patients are increasingly incurring higher costs associated with health care utilization, out-of-pocket expenditures, and workplace productivity losses. There is a pressing need for cost-effective strategies to address these burdens on patients and families affected by IBD.

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“…We found that direct costs varied widely between studies. A number of studies reported direct costs, but did not include direct out-of-pocket costs to patients, rather reporting on the direct costs of health care (26,30,31,36). Overall, patients with UC incurred lower direct costs than patients with CD.…”

Section: Discussionmentioning

confidence: 99%

A Narrative Review of Financial Burden, Distress, and Toxicity of Inflammatory Bowel Diseases in the United States

Kahn-Boesel,

Cautha,

Ufere

et al. 2023

Am J Gastroenterol

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INTRODUCTION: Inflammatory bowel diseases (IBD) affect >3 million Americans and are associated with tremendous economic burden. Direct patient-level financial impacts, financial distress, and financial toxicity are less well understood. We aimed to summarize the literature on patient-level financial burden, distress, and toxicity associated with IBD in the United States. METHODS:We conducted a literature search of US studies from 2002 to 2022 focused on direct/indirect costs, financial distress, and toxicity for patients with IBD. We abstracted study objectives, design, population characteristics, setting, and results.

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The Cost of Crohnʼs Disease

Cited by 28 publications

References 24 publications

<p>Evaluating the clinical and economic consequences of using video capsule endoscopy to monitor Crohn’s disease</p>

<p>Evaluating the clinical and economic consequences of using video capsule endoscopy to monitor Crohn’s disease</p>

The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn’s & Colitis Foundation

A Narrative Review of Financial Burden, Distress, and Toxicity of Inflammatory Bowel Diseases in the United States

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