Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Abstract

View the peer-reviewed version (peerj.com/articles/587), which is the preferred citable publication unless you specifically need to cite this preprint. expenditures for CD, UC, and all IBD were $10,364 (N=238), $7,827 (N=95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N=276,372, p<0.05). Publicly insured patients incurred the highest costs ($18,067), over privately insured ($8,014, p<0.05) or uninsured patients ($5,129, p<0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p<0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI 1.08-4.19) or no insurance (OR 4.94,, with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI 0.15-0.95) and office-based care (OR 0.21, CI 0.07-0.62). Conclusions: In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs. Disclosures: Authors report no conflicts of interest as described by PeerJAuthor Contributions: Michelle D Park, BA -obtaining funding source, planning and conducting the study, collecting and interpreting data, and drafting/editing the manuscript. Jay Bhattacharya, MD, PhD -planning the study, interpreting data, and editing the manuscript. KT Park, MD, MS -obtaining funding source, planning and conducting the study, collecting and interpreting data, and drafting/editing the manuscript. Aim: To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US). Methods:We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn's disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures.Results: Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N=238), $7,827 (N=95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N=276,372, p<0.05). Publicly insured patients incurred the highest costs ($18,067), over privately insured ($8,014, p<0.05) or uninsured patients ($5,129, p<0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p<0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI 1.08-4.19) or no insurance (OR 4.94,, with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-b...

An evaluation of health care expenditures in Crohn's disease using the United States Medical Expenditure Panel Survey from 2003 to 2013

“…7 It also reports total expenditures per patient per year as $12,542 which was lower compared to previous estimates of $17,500 4 to $24,500 5 ; and higher compared to a previous estimate of $10,364. 20 Further, in the differencein-differences estimations, total and prescription expenditures in respondents with Crohn's disease had a higher increase compared to respondents without Crohn's disease pre-post FDA approvals of new biologics and the American College of Gastroenterology Crohn's disease treatment guidelines.…”

“…In contrast, Park and colleagues reported that inpatient expenditures represented a large proportion of total expenditures (36%) compared to prescriptions (8%) using MEPS data spanning from 1996 to 2011. 20 Similarly, Gibson and colleagues reported that inpatient expenditures represented 46% of total expenditures while prescription expenditures only represented 12%. 6 This appears reasonable given that costs may have shifted from inpatient to prescription expenditures due to the introduction of biologics in recent years.…”

Inflammatory bowel disease: cost-driving factors and impact of cost sharing on outpatient resource utilization

“…The prevalence for IBD has been increasing in recent years, about 1.2–1.6 million affected patients . The annual direct expenditure for IBD is about $6.7 billion, making the annual cost per patient about $10 000 for CD and $7500 for UC . Additionally, the indirect IBD cost (employee absenteeism) were estimated to be about $249 million in United States (2006's value) .…”

“…Previous studies have identified several factors that associated with higher expenditure in IBD. These factors include age, insurance status, income, body mass index (BMI), gender, race, smoking status and education . However, these studies used different population groups.…”