Chronic inflammatory disease expenditures nearly double over last 2 decades
AUSTIN, Texas — The overall health care cost of caring for patients with inflammatory bowel disease has increased at a rapid rate over the last 20 years, according to data presented at Crohn’s and Colitis Congress.
However, over the last two decades, the data demonstrate that there has been a shift in what the primary driver of cost is.
“Compared to healthy controls, we know that individuals with inflammatory bowel disease experience higher health care costs,” Benjamin Click, MD, a gastroenterologist at Cleveland Clinic, told Healio Gastroenterology and Liver Disease. “What we have also seen from prior studies is that historically, health care utilization such as hospitalizations and surgery accounted for the majority of expenditures.”
To assess changes in cost of IBD care over time, Click and colleagues assessed The Medical Expenditure Panel Survey (MEPS), a nationally representative database of health care use and expenditure data collected since 1998.
Additionally, the researchers aimed to determine shifts in cost-drivers over time and wanted to compare IBD with rheumatoid arthritis to assess for IBD specific changes.
“What we don’t know is that if that is unique to inflammatory bowel disease or rather that is across all chronic inflammatory diseases as a whole,” Click said in an interview. “This was a comparative study looking at not only inflammatory bowel disease patients, but comparing them to patients with rheumatoid arthritis, which is another chronic inflammatory condition for which biologics are often utilized. This allowed us to look at trends in health care spending over essentially the biologic era and compare them to patients with rheumatoid arthritis.”
The researchers assessed total annual, outpatient, inpatient, emergency and pharmacy expenditures in both patients with IBD (n = 641) and RA (n = 641).
They used three separate time periods – 1998-2001, 2006-2009 and 2012-2015 –to compare expenditures over time.
Median per-patient annual health care expenditure in patients with IBD was $6,570 compared with $4,010 in patients with RA across all years of the study.
Total annual spending increased approximately 2.2 times (95% CI, 1.6-3; P < .01) over the study period and was 36% higher in IBD than RA (P = 0.01).
Pharmaceutical spending increased more than fourfold (95% CI, 3.2-6.1; P < .01) and became the largest cost category (44% total).
However, inpatient expenses in IBD decreased 40% over the study period.
“The cost for caring for inflammatory bowel disease has more than doubled over the last 20 years,” Click said. “Looking back at the early time period, health care utilization accounted for the majority of expenditures, but over the course of the study we saw a significant increase in pharmaceutical spending. With that concurrent increase in pharmaceutical spending, we actually saw a reduction in inpatient-related costs. It raises the question whether by utilizing more biologics, are we actually driving down inpatient health care spending?”
Click noted that compared with RA, the researchers did not see a significant difference in the overall rate of change, suggesting that the same trends seen in IBD may also be seen in other chronic inflammatory conditions as well.
“The overall health care cost for caring for this patient population is increasing at a rapid rate and we need to focus and determine what are some potential strategies for managing these expenditures and how can we improve upon our care algorithms to better reign in overall cost of care,” he said.
When asked how to address the growing costs associated with treating patients with IBD, Click said it is likely a multifactorial response.
He said health care professionals need to better stratify the onset of patients’ disease and use the early window of opportunity to recognize those patients at risk of a more severe disease course and use the best therapies upfront.
“Precision medicine efforts to identify which patients may respond preferentially to different medications is certainly needed,” he said. “Furthermore, inflammatory bowel disease care is influenced not only by the luminal inflammation, but also by multiple comorbidities, particularly mental and behavioral health such as anxiety or depression. Incorporating efforts to recognize and appropriately address those comorbidities are likely to have a significant and cost-effective impact on how we care for this population.” – by Ryan McDonald
Click B, et al. Poster 22. Presented at: Crohn’s and Colitis Congress; Jan. 23-25, 2020; Austin, Texas.
Disclosure: Click reports serving as a consultant for Takeda and Target PharmaSolutions.