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Predicting Costs of Care for Patients With Inflammatory Bowel Diseases

Published:December 03, 2016DOI:https://doi.org/10.1016/j.cgh.2016.11.027
      Inflammatory bowel disease (IBD) is a heterogeneous group of chronic inflammatory disorders affecting nearly 2 million Americans.
      • Kappelman M.D.
      • Moore K.R.
      • Allen J.K.
      • et al.
      Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a commercially insured US population.
      • Molodecky N.A.
      • Soon I.S.
      • Rabi D.M.
      • et al.
      Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review.
      Patients with IBD and its subgroups ulcerative colitis and Crohn’s disease often experience a variable disease course and unpredictable responses to treatment. Consequently, a considerable portion of IBD patients require hospitalization (24%–83%), surgery (39%–82%), or aggressive medical therapy (42%–62% steroids, 6%–24% biologics) at some point in their life, resulting in a large financial burden.
      • Cohen R.D.
      • Larson L.R.
      • Roth J.M.
      • et al.
      The cost of hospitalization in Crohn’s disease.
      • Silverstein M.D.
      • Loftus E.V.
      • Sandborn W.J.
      • et al.
      Clinical course and costs of care for Crohn’s disease: Markov model analysis of a population-based cohort.
      • Bernstein C.N.
      • Loftus E.V.
      • Ng S.C.
      • et al.
      Epidemiology and Natural History Task Force of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD)
      Hospitalisations and surgery in Crohn’s disease.
      • Vester-Andersen M.K.
      • Prosberg M.V.
      • Jess T.
      • et al.
      Disease course and surgery rates in inflammatory bowel disease: a population-based, 7-year follow-up study in the era of immunomodulating therapy.
      Recent estimates place the total cost of Crohn’s disease in the United States as high as $15.5 billion annually,
      • Yu A.P.
      • Cabanilla L.A.
      • Wu E.Q.
      • et al.
      The costs of Crohn’s disease in the United States and other Western countries: a systematic review.
      and ulcerative colitis as high as $14.9 billion
      • Cohen R.D.
      • Yu A.P.
      • Wu E.Q.
      • et al.
      Systematic review: the costs of ulcerative colitis in Western countries.
      annually, with nearly a third of costs stemming from indirect sources (eg, missed work). A small percentage of patients contribute disproportionately to overall health care expenditures because the upper quartile accounts for 80% of expenses.
      • Hay J.W.
      • Hay A.R.
      Inflammatory bowel disease: costs-of-illness.
      • Feagan B.G.
      • Vreeland M.G.
      • Larson L.R.
      • et al.
      Annual cost of care for Crohn’s disease: a payor perspective.
      • Park K.T.
      • Colletti R.B.
      • Rubin D.T.
      • et al.
      health insurance paid costs and drivers of costs for patients with Crohn’s disease in the United States.
      These patients often require repeat admissions and surgeries for refractory inflammation, complications of IBD, chronic pain, or psychosomatic issues.
      • Click B.H.
      • Gajendran M.
      • Rivers C.R.
      • et al.
      Sa1144 association between surgical anastomotic technique and postoperative healthcare financial burden in patients with Crohn’s disease: a longterm, prospective study.
      With a health care system transitioning away from fee-for-service models and toward more value-based reimbursement strategies,
      • Patel K.
      • Presser E.
      • George M.
      • et al.
      Shifting away from fee-for-service: alternative approaches to payment in gastroenterology.
      recognizing potential avenues of cost reduction and quality improvement is imperative.
      • Camilleri M.
      • Katzka D.A.
      Enhancing high value care in gastroenterology practice.
      Proactive identification and prognostic tools for high-cost IBD patients, as well as reactive early-warning detection systems such as remote monitoring, may prevent potentially avoidable unplanned care.
      • Riaz M.S.
      • Atreja A.
      Personalized technologies in chronic gastrointestinal disorders: self-monitoring and remote sensor technologies.
      • Ramos-Rivers C.
      • Regueiro M.
      • Vargas E.J.
      • et al.
      Association between telephone activity and features of patients with inflammatory bowel disease.
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      Linked Article

      • Factors That Predict High Health Care Utilization and Costs for Patients With Inflammatory Bowel Diseases
        Clinical Gastroenterology and HepatologyVol. 15Issue 3
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          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.
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