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 Inflammatory bowel disease (IBD) involves chronic or recurring
inflammation of the gastrointestinal tract. People with Crohn's can
have inflammation throughout the digestive tract, while in
ulcerative colitis, only the large intestine and the rectum become
inflamed.
Researchers examined data from 2007 to 2016 for almost 53,000 people
with IBD who had either private health insurance or Medicare
Advantage coverage with both medical and pharmacy benefits. They
also looked at data on 12 to 14 million people without IBD.
Overall, average annual costs for patients with IBD were $22,987
compared with $6,956 without IBD, the study found.
And out-of-pocket costs like co-payments and deductibles were more
than doubled with IBD: $2,213 a year compared with $979 annually
without IBD.
"We think the out of pocket costs are substantial underestimates
since we cannot capture all the indirect costs the patients actually
absorbed, such as lost wages, costs to caregivers, transportation,
and opportunity loss at work," lead study author Dr. K.T. Park of
Stanford Health Care and Packard Children's Health in Palo Alto,
California.
"Out of pocket costs are difficult to capture holistically and each
patient's health plans can be quite different," Park, also an
employee of Genentech Inc. and a shareholder in Roche Group SSM,
said by email. "Patients' responsible costs for medications and all
the numerous health services can be cumulative and compounding,
especially in that first year of diagnosis."
Costs for patients with IBD averaged $26,555 over the first year
after diagnosis, researchers report in Inflammatory Bowel Diseases.
This didn't include the cost of insurance premiums.
Several factors were tied to higher costs with IBD, including the
use of expensive biotech drugs, opioids, or steroids; emergency room
use; anemia; relapsing disease; and mental illness.
When patients had at least one emergency room visit in a year, for
example, average annual costs were $37,759 compared to $15,237
without an ER visit.
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And when patients had a mental illness, annual average costs were
$35,740 compared to $18,520 without a psychological disorder.
Average costs for IBD were stable from year to year before 2012.
After that, however, costs have been rising more sharply.
The study wasn't a controlled experiment designed to prove whether
or how IBD might directly impact health costs for insurance
companies or out-of-pocket costs for patients. Researchers also
compared IBD patients to healthy people, so it's not possible to say
whether IBD is more or less costly than other chronic illnesses.
One limitation is that researchers lacked data on disease severity
for people with IBD, said senior study author Dr. Caren Heller,
chief scientific officer for the Crohn's & Colitis Foundation.
"Crohn's and ulcerative colitis are very individual diseases, and
understanding more fully the relationship between the severity of
the disease and the therapies patients were using, would be
beneficial to segment and analyze costs of subpopulations," Heller
said by email.
"Also, it is not possible to evaluate in administrative claims data
for all out of pocket and indirect costs such as lost earnings,
productivity, leisure time lost, child care, or over the counter
medications. But those costs exist and they are a tremendous burden
on our patients," Heller added.
Worldwide, IBD is becoming more common, especially in newly
industrialized countries, making it essential to determine cost
drivers that may make it challenging for patients to afford care,
said Dr. Chang Kyun Lee of the Kyung Hee University College of
Medicine in Seoul, South Korea.
"Given that IBD is a chronic and incurable disease with early onset
and low mortality, the economic burden of IBD is becoming an
increasingly important public health issue," Lee, who wasn't
involved in the study, said by email.
SOURCE: http://bit.ly/31gk6L8 Inflammatory Bowel Diseases, online
May 21, 2019.
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