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Severe disease associated with high health care use in IBD
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Patients with inflammatory bowel disease affected by more severe disease had higher health care use and costs, according to the results of recent study.
“In an era of health care reform, patient-centered medical homes and transformation of specialty care, health care utilization and cost have become central to chronic disease programs,” Miguel Regueiro, MD, AGAF, FACG, FACP, professor of medicine at University of Pittsburgh, told Healio Gastroenterology. “Gastroenterologists managing patients with inflammatory bowel disease are often faced with treatment challenges, but now, also, improving quality and decreasing cost. Our study researched a large population of IBD patients to identify factors that are associated with utilization.”
Miguel Regueiro
Regueiro and colleagues analyzed registry data from 2009 to 2013 to compare financial charges for all health care services incurred by 100 IBD patients with the highest medical charges vs. 300 patients with the median total charges.
The median charge value of the top 5% of patients with the highest medical costs was $691,081 compared with $14,322 for the patients with charges closest to the median. Total charges amassed by the top 5% were $95,030,747 vs. $4,527,035 for the 300 patients in the median range.
Patients with the highest charges were more likely to be unemployed (P < .0001), black (P = .013), have comorbid psychiatric illness (P = .002), hypertension (P = .01) or diabetes (P = .004), use opiates (P < .0001), or have perianal disease (P = .002), penetrating disease (P < .0001) or extensive colitis (P = .01).
Multivariate analysis showed independent associations with high charges included:
- unemployment in Crohn’s disease (OR = 3.04; 95% CI, 1.32-7.02) and ulcerative colitis (OR = 2.68; 95% CI, 1.2-5.99);
- psychiatric illness in UC (OR = 2.08; 95% CI, 1.03-4.19);
- opiate use in CD (OR = 5.61; 95% CI, 2.67-11.82) and UC (OR = 5.14; 95% CI, 2.52-10.48);
- prior surgery in CD (OR = 3.29; 95% CI, 1.59-6.82) and UC (OR = 2.72; 95% CI, 1.51-5.9);
- penetrating CD (OR = 3.29; 95% CI, 1.02-10.62); and
- corticosteroid requirement in CD (OR = 3.78; 95% CI, 1.86-7.65) and UC (OR = 2.98; 95% CI, 1.51-5.9).
“Not only did severe disease correlate with utilization, behavioral health, pain and opioid use were risk factors for high health care use,” Regueiro said. “Identifying factors associated with severe disease early and treating appropriately may avoid future complications. Equally important, providing a multidisciplinary team that incorporates psychosocial and pain specialists is the new model of care for IBD. Hopefully, personalized approaches to factors predictive of utilization will result in improved quality care at a reduced cost.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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