Depression and Health Care Use in Patients With Inflammatory Bowel Disease

Wong, Jessie J.; Sceats, Lindsay A.; Dehghan, Melody; Wren, Anava A.; Sellers, Zachary M.; Limketkai, Berkeley N.; Bensen, Rachel; Kin, Cindy; Park, K T

doi:10.1093/ecco-jcc/jjy145

Cited by 27 publications

(26 citation statements)

References 37 publications

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“…For a health system to find financial success within this framework, it must control unnecessary costs, especially for patients with chronic or relapsing conditions such as IBD. Thus, studies that can highlight interventions that might prevent costly imaging studies 15 or ED use and improve patient quality of care and outcomes will be important for providers to gain knowledge about value-based care.…”

Section: Introductionmentioning

confidence: 99%

The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn’s & Colitis Foundation

Park

Ehrlich

Allen

et al. 2019

Inflammatory Bowel Diseases

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303

189

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Background The Crohn’s & Colitis Foundation’s Cost of Inflammatory Bowel Disease (IBD) Care Initiative seeks to quantify the wide-ranging health care costs affecting patients living with IBD. We aimed to (1) describe the annualized direct and indirect costs of care for patients with Crohn’s disease (CD) or ulcerative colitis (UC), (2) determine the longitudinal drivers of these costs, and (3) characterize the cost of care for newly diagnosed patients. Methods We analyzed the Optum Research Database from the years 2007 to 2016, representing commercially insured and Medicare Advantage–insured patients in the United States. Inclusion for the study was limited to those who had continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months before through 12 months after the index date of diagnosis). The value of patient time spent on health care was calculated as number of workplace hours lost due to health care encounters multiplied by the patients’ estimated average wage derived from the Bureau of Labor Statistics. Comparisons between IBD patients and non-IBD patients were analyzed based on demographics, health plan type, and length of follow-up. We used generalized linear models to estimate the association between total annual costs and various patient variables. Results There were 52,782 IBD patients (29,062 UC; 23,720 CD) included in the analysis (54.1% females). On a per-annual basis, patients with IBD incurred a greater than 3-fold higher direct cost of care compared with non-IBD controls ($22,987 vs $6956 per-member per-year paid claims) and more than twice the out-of-pocket costs ($2213 vs $979 per-year reported costs), with all-cause IBD costs rising after 2013. Patients with IBD also experienced significantly higher costs associated with time spent on health care as compared with controls. The burden of costs was most notable in the first year after initial IBD diagnosis (mean = $26,555). The study identified several key drivers of cost for IBD patients: treatment with specific therapeutics (biologics, opioids, or steroids); ED use; and health care services associated with relapsing disease, anemia, or mental health comorbidity. Conclusion The costs of care for IBD have increased in the last 5 years and are driven by specific therapeutics and disease features. In addition, compared with non-IBD controls, IBD patients are increasingly incurring higher costs associated with health care utilization, out-of-pocket expenditures, and workplace productivity losses. There is a pressing need for cost-effective strategies to address these burdens on patients and families affected by IBD.

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Section: Introductionmentioning

confidence: 99%

The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn’s & Colitis Foundation

Park

Ehrlich

Allen

et al. 2019

Inflammatory Bowel Diseases

Self Cite

303

189

View full text Add to dashboard Cite

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“…Patients with IBS frequently live with symptoms of psychological distress, including anxiety or depression and report that their quality of life (QoL) becomes poorer as the severity of their disease increases [10][11][12][13][14][15][16][17] . Moreover there is increasing evidence that experiencing such distress in a continued way could cause IBD activity to increase 18 .…”

mentioning

confidence: 99%

The effect of a mindfulness-based therapy on different biomarkers among patients with inflammatory bowel disease: a randomised controlled trial

González-Moret

Cebolla

Cortés

et al. 2020

Sci Rep

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Mindfulness-based interventions have shown some efficacy in decreasing stress levels and improving quality of life. However, so far, only a few studies have studied this type of intervention among patients with inflammatory bowel disease and none of them have studied their effects on inflammatory biomarkers. This current study was a two-armed, single-centre, randomised (2:1 ratio) controlled trial used to evaluate the effects of a mindfulness-based intervention (n = 37) compared to standard medical therapy (n = 20) in patients with Crohn's disease or ulcerative colitis. The mindfulness intervention blended four internet-based therapy modules with four face-to-face support sessions. The outcomes we assessed were faecal calprotectin (primary outcome), C-reactive protein, and cortisol levels measured in hair samples at several timepoints. The between-group analysis highlighted significant decreases in faecal calprotectin and in C-reactive protein levels in the mindfulness-based intervention group compared to the standard medical therapy group at the six-month follow-up (faecal calprotectin: −367, [95% CI: −705, −29], P = 0.03; C-reactive protein: −2.82, [95% CI: −5.70, 0.08], P = 0.05), with moderate to large effect sizes (faecal calprotectin: ηp 2 = 0.085; C-reactive protein: ηp 2 = 0.066). We concluded that mindfulness-based therapy administered as part of standard clinical practice effectively improves inflammatory biomarkers in patients diagnosed with inflammatory bowel disease.

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“…Patients with anxiety and depression require more postoperative narcotics and have higher rates of chronic pain after surgery . Psychiatric disorders are also associated with increased costs, as depressed IBD patients are more likely to seek healthcare in the form of emergency room visits and imaging . In today’s quality‐ and cost‐conscious healthcare environment, addressing this modifiable risk factor has the potential to meaningfully improve outcomes for patients and surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Our primary outcomes of interest were anxiety and depression diagnoses, defined as one or more inpatient or two or more outpatient diagnoses on separate dates in the year before or after the index date. These criteria were conservatively modified from a previously validated claims‐based definition to require diagnoses to occur in 1 year instead of 2 years to better assess clinical status around the time of surgery . Anxiety and depression diagnosis codes for outcome classification are included in Appendix in the online Supporting Information.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with inflammatory bowel disease (IBD) suffer from higher rates of anxiety and depression than the general population . Anxiety and depression are associated with adverse clinical outcomes such as frequent flares, lower treatment adherence and compliance, reduced quality of life, and increased healthcare utilization and expenditure . In addition to common challenges faced by chronically ill patients, many IBD patients undergo major surgery that may result in further psychological stressors.…”

Section: Introductionmentioning

confidence: 99%

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Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients

et al. 2019

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Aim Patients with inflammatory bowel disease (IBD) are diagnosed with anxiety/depression at higher rates than the general population. We aimed to determine the frequency of anxiety/depression among IBD patients and the temporal association with abdominal surgery and stoma formation. MethodWe conducted a retrospective cohort study in adult patients with IBD using difference-in-difference methodology and a large commercial claims database (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). Outcomes were anxiety/depression diagnoses before and after major abdominal surgery or stoma formation. ResultsWe identified 10 481 IBD patients who underwent major abdominal surgery, 18.8% of whom underwent stoma formation, and 41 924 nonsurgical age-and sexmatched IBD controls who were assigned random index dates. Rates of anxiety and depression increased among all cohorts (P < 0.001). Surgical patients had higher odds of anxiety [one surgery, adjusted OR 6.90 (95% CI 6.11-7.79), P < 0.001; two or more surgeries, 7.53 (5.99-9.46), P < 0.001] and depression [one surgery, 6.15 (5.57-6.80), P < 0.001; two or more surgeries, 6.88 (5.66-8.36), P < 0.001] than nonsurgical controls. Undergoing multiple surgeries was associated with a significant increase in depression from 'pre' to 'post' time periods [1.43 (1.18-1.73), P < 0.001]. Amongst surgical patients, stoma formation was independently associated with anxiety [1.40 (1.17-1.68), P < 0.001] and depression [1.23 (1.05-1.45), P = 0.01]. New ostomates experienced a greater increase in postoperative anxiety [1.24 (1.05-1.47), P = 0.01] and depression [1.19 (1.03-1.45), P = 0.01] than other surgical patients.Conclusion IBD patients who undergo surgery have higher rates of anxiety and depression than nonsurgical patients. Rates of anxiety and depression increase following surgery. Stoma formation represents an additional risk factor. These findings suggest the need for perioperative psychosocial support services. Keywords Stomas, depression, anxiety, inflammatory bowel diseaseWhat does this paper add to the literature? The relationship between surgery for inflammatory bowel disease, stoma formation, and anxiety and depression has been poorly quantified. We found that surgery for inflammatory bowel disease increased rates of anxiety and depression. Multiple surgeries and stoma-forming surgeries placed patients at additional risk. This suggests the need for additional psychosocial support services for these high-risk patients.

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Depression and Health Care Use in Patients With Inflammatory Bowel Disease

Cited by 27 publications

References 37 publications

The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn’s & Colitis Foundation

The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn’s & Colitis Foundation

The effect of a mindfulness-based therapy on different biomarkers among patients with inflammatory bowel disease: a randomised controlled trial

Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients

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