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

Abstract

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.

Healthcare resource utilization and costs associated with inflammatory bowel disease among patients with chronic inflammatory diseases: a retrospective cohort study

“…While it was anticipated that patients with IBD and CID would incur higher costs than patients with CID alone, this study is the first to quantify the incremental costs and HRU associated with IBD among patients with AS, PsA, PsO, or RA, stratified by type of CID. Of note, the difference in total all-cause healthcare costs found in our study ($18,500) is similar to that observed in recent analyses which assessed the incremental burden of patients with IBD versus non-IBD controls (IBD: $16,031 [27], CD only: $17,463 [32], UC only: $11,029 [33]). Although comparisons with results from other analyses are prone to confounding, this suggests that the incremental burden associated with IBD in a population of patients with CID is similar to that observed in the general population.…”

“…While multiple previous studies have assessed the incremental burden of IBD relative to controls without IBD [23][24][25][26][27], little is known on the burden of IBD in patients with pre-existing CID. A recent real-world analysis of the economic burden associated with IBD among patients with PsA and AS in the United States (US) showed that compared to patients without IBD, those with IBD had significantly higher total healthcare costs-up to 27% higher in patients with PsA and 38% higher among patients with AS [28].…”

Infliximab Versus Biosimilars for IBD: Is It Better to Fight Than Switch?

“…When accounting for all medical therapy-related costs in IBD, biologic agents accounted for an impressive 85.7% of total costs. These findings have been confirmed across multiple studies, including a recent analysis conducted by the Crohn's and Colitis Foundation using a separate claimsbased dataset [2]. Rapid increases in biologic medication costs have not been limited to inflammatory bowel diseasethis is one the most rapidly expanding current sources of medical expenses across all disease states [3].…”

Aminosalicylate withdrawal following escalation to immunomodulators or biologics in ulcerative colitis: cost saving, convenient and does not compromise efficacy

“…In this cohort as in most IBD centres worldwide, the majority of patients were of relatively young age and would therefore potentially require biologics, immunomodulators and/or 5‐ASA therapies for decades post‐diagnosis. Drug costs are therefore a huge and growing impost to health payers which cannot be ignored by clinicians and should be mitigated wherever possible . Data assessing clinical outcomes following discontinuation of 5‐ASA therapy with or without concomitant immunomodulating therapy are limited.…”