By Lisa Rapaport
(Reuters Health) - 7/6/2019
People with inflammatory bowel disease (IBD) - either Crohn's disease or ulcerative colitis - may incur health costs more than three times higher than individuals without these conditions, a U.S. study suggests.
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, online May 21.
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 department 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 ED visit.
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.
Inflam Bowel Dis 2019.