Gastroenterology

Gastroenterology

Volume 135, Issue 6, December 2008, Pages 1907-1913
Gastroenterology

Clinical—Alimentary Tract
Direct Health Care Costs of Crohn's Disease and Ulcerative Colitis in US Children and Adults

https://doi.org/10.1053/j.gastro.2008.09.012Get rights and content

Background & Aims

Data regarding the health care costs of inflammatory bowel disease (IBD) in the United States are limited. The objectives of this study were to estimate the direct costs of Crohn's disease (CD) and ulcerative colitis (UC) in the United States, describe the distribution of costs among inpatient, outpatient, and pharmaceutical services, and identify sociodemographic factors influencing these costs.

Methods

We extracted medical and pharmacy claims from an administrative database containing insurance claims from 87 health plans in 33 states, occurring between 2003 and 2004. We identified cases of CD and UC using an administrative definition. For each case, we selected up to 3 non-IBD controls. Claims were classified as inpatient, outpatient, or pharmaceutical according to Current Procedural Terminology codes or National Drug Codes. Costs were based on the paid amount of each claim. IBD-attributable costs were estimated by subtracting costs for non-IBD patients from those for patients with IBD. Logistic regression was used to identify the sociodemographic factors affecting these costs.

Results

We identified 9056 patients with CD and 10,364 patients with UC. Mean annual costs for CD and UC were $8265 and $5066, respectively. For CD, 31% of costs were attributable to hospitalization, 33% to outpatient care, and 35% to pharmaceutical claims. The corresponding distribution for UC was 38%, 35%, and 27%, respectively. Costs were significantly higher for children younger than 20 years compared with adults, but this did not vary substantially by sex or region.

Conclusions

This study demonstrates a substantial economic burden of IBD and can be used to inform health policy.

Section snippets

Study Design and Data Source

In this cross-sectional study, we analyzed the medical, surgical, and pharmaceutical insurance claims contained in the PharMetrics Patient-Centric Database (IMS Health, Watertown, MA) for the period from January 1, 2003, to December 31, 2004. This longitudinal, patient-level database has been used in previous epidemiologic studies of IBD11 and at the time of this study included claims from 87 health plans in 33 states. The included plans capture a geographically diverse sample of commercially

Study Population

Our study population included 9056 patients with CD and their 24,829 matched controls and 10,364 patients with UC and their 28,160 matched controls (Table 1). The mean age of patients with CD and patients with UC was 42 years (SD, 13 years) and 45 years (SD, 12 years), respectively. Fifty-six percent of patients with CD and 53% of patients with UC were women. Each of the 4 major US census regions was adequately represented in our patient population. There were no statistically significant

Discussion

This study provides an updated estimate of the treatment costs of CD and UC in the United States, a necessary step in understanding the overall burden of IBD in this country. In our sample of nearly 20,000 US children and adults with IBD, we found that the mean treatment costs for CD were $8265 per year and for UC were $5066 per year. As with many illnesses, a disproportionate amount of the overall societal costs resulted from the individuals with the highest resource utilization, as indicated

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    The authors disclose the following: Supported in part by National Center for Research Resources grant 1K12 RR023248-04 (to M.D.K.) and National Institute for Diabetes and Digestive and Kidney Diseases grant 5P30 DK034987 (to M.D.K.).

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