Mental Health Costs of Inflammatory Bowel Diseases

Abstract

Background Mental health diagnoses (MHDs) were identified as significant drivers of inflammatory bowel disease (IBD)-related costs in an analysis titled “Cost of Care Initiative” supported by the Crohn’s & Colitis Foundation. In this subanalysis, we sought to characterize and compare IBD patients with and without MHDs based on insurance claims data in terms of demographic traits, medical utilization, and annualized costs of care. Methods We analyzed the Optum Research Database of administrative claims from years 2007 to 2016 representing commercially insured and Medicare Advantage insured IBD patients in the United States. Inflammatory bowel disease patients with and without an MHD were compared in terms of demographics (age, gender, race), insurance type, IBD-related medical utilization (ambulatory visits, emergency department [ED] visits, and inpatient hospitalizations), and total IBD-related costs. Only patients with costs >$0 in each of the utilization categories were included in the cost estimates. Results Of the total IBD study cohort of 52,782 patients representing 179,314 person-years of data, 22,483 (42.6%) patients had at least 1 MHD coded in their claims data with a total of 46,510 person-years in which a patient had a coded MHD. The most commonly coded diagnostic categories were depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Compared with patients without an MHD, a significantly greater percentage of IBD patients with MHDs were female (61.59% vs 48.63%), older than 75 years of age (9.59% vs 6.32%), white (73.80% vs 70.17%), and significantly less likely to be younger than 25 years of age (9.18% vs 11.39%) compared with those without mental illness (P < 0.001). Patients with MHDs had significantly more ED visits (14.34% vs 7.62%, P < 0.001) and inpatient stays (19.65% vs 8.63%, P < 0.001) compared with those without an MHD. Concomitantly, patients with MHDs had significantly higher ED costs ($970 vs $754, P < 0.001) and inpatient costs ($39,205 vs $29,550, P < 0.001) compared with IBD patients without MHDs. Patients with MHDs also had significantly higher total annual IBD-related surgical costs ($55,693 vs $40,486, P < 0.001) and nonsurgical costs (medical and pharmacy) ($17,220 vs $11,073, P < 0.001), and paid a larger portion of the total out-of-pocket cost for IBD services ($1017 vs $905, P < 0.001). Conclusion Patients whose claims data contained both IBD-related and MHD-related diagnoses generated significantly higher costs compared with IBD patients without an MHD diagnosis. Based on these data, we speculate that health care costs might be reduced and the course of patients IBD might be improved if the IBD-treating provider recognized this link and implemented effective behavioral health screening and intervention as soon as an MHD was suspected during management of IBD patients. Studies investigating best screening and intervention strategies for MHDs are needed.

Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis

“…[13][14][15][16][17] An analysis of administrative claims data demonstrated that both direct and indirect costs of care were significantly higher in patients with IBD and a co-existent common mental disorder, compared with IBD patients without. 18 However, although numerous studies have reported on symptoms of anxiety and depression in patients with IBD, these demonstrate greatly varying prevalence rates, up to 80% in some studies. 19,20 Some of this variation may reflect differences in the psychometric tools used to define the presence or absence of these disorders, 19,21,22 but uncertainties remain about the magnitude of this problem, 23 as well as the strength of the association between symptoms of common mental disorders and type of IBD, 13,24,25 the influence of IBD activity, [26][27][28] and the impact of sex.…”

Depression and Anxiety Disorders in Patients With Inflammatory Bowel Disease

“…Anxiety and depression are the most common psychological disorders for patients with IBD. One recent study showed that patients with IBD and mental health disease generated significantly higher costs compared with patients without mental disorders (4). Psychological disorders in patients with IBD may lead to high risk of relapse and poor treatment compliance.…”

Understanding and managing psychological disorders in patients with inflammatory bowel disease: a practical guide

“…Differences in the provision of psychiatric support at local community level make it hard to quantify with precision the impact of these disorders on IBD outpatient and emergency services in the UK. However, reports from Australia, the USA and the UK suggest that an integrated psychiatric service for patients with IBD, offered along the lines we advocate below, may reduce this impact and its related costs 6–8…”