Inflammatory Bowel Disease Means High Health Costs for Patients
The need for more hospital visits, and expensive drugs are important drivers of overall cost.
People with inflammatory bowel disease may have health costs that are more than three times higher than what they might otherwise incur, according to research published in May 2019 in the journal Inflammatory Bowel Diseases.
Inflammatory bowel disease (IBD) involves chronic or recurring inflammation of the gastrointestinal tract. One form, Crohn’s disease, can create inflammation throughout the digestive tract but most often affects the portion of the small intestine before the colon. With the other form, ulcerative colitis, only the large intestine and rectum become inflamed.
For the study, researchers looked at health costs for approximately 12 to 14 million patients nationwide with either private medical insurance or coverage through Medicare, including almost 53,000 people diagnosed with IBD. To assess costs, they examined insurance records for medical and pharmacy claims from 2007 to 2016.
IBD patients had average annual costs of $22,987 compared with $6,956 for those without IBD.
“We found that patients with IBD have higher costs compared with those without a diagnosis of IBD, driven by factors including associated hospitalizations or emergency department use; therapies such as opioids, steroids, or biologics; and medical conditions outside the digestive system but associated with IBD, such as anemia or psychiatric illness,” says Caren Heller, MD, the senior author of the study and the chief scientific officer for the Crohn’s & Colitis Foundation.
“IBD patients also had higher out-of-pocket and indirect costs,” Dr. Heller says.
IBD was associated with more than twice the out-of-pocket costs for things like copayments and deductibles, the study found. Out-of-pocket costs for people with IBD were $2,213 a year compared with $979 annually for people without the condition.
Excluding the cost of insurance premiums, costs for IBD patients averaged $26,555 over the first year after diagnosis.
The study didn’t directly assess disease severity. But costs did appear higher when patients had health problems serious enough to send them to the emergency room.
IBD patients who had at least one emergency room visit in a year had average annual costs of $37,759 compared with $15,237 for those who did not require an ER visit.
Some previous research, published in Clinical and Experimental Gastroenterology in July 2015, has also linked IBD to an increased risk of mood disorders like anxiety or depression, particularly when IBD symptoms are most severe.
In the current study, IBD patients with a mental illness had annual average costs of $35,740 compared with $18,520 without a psychological disorder.
“Better disease control means less need for acute care services, less time lost from work, and less need for acute therapies (medications and surgeries), which has the potential to lower costly components of care,” says Jordan Shapiro, MD, a gastroenterology research fellow at Baylor College of Medicine in Houston, who wasn’t involved in the study.
“The psychological well-being of our patients is also important, as depression and anxiety are linked to more symptoms, poorer quality of life, and greater costs of care,” Dr. Shapiro says.
Why Costs Have Increased Even More in Recent Years
While average costs for IBD patients were stable from year to year before 2012, costs started rising after that. The cost of biologics, injected drugs made from living organisms, appears to have played a role in rising costs in recent years.
Fewer than one in five IBD patients took biologics, the study found. But IBD patients who did use biologics had average annual costs two to three times higher than those of other IBD patients.
“The cost of expensive drugs is by far the most important driver of total costs,” says Bas Oldenburg, MD, PhD, a gastroenterologist at University Medical Centre Utrecht in the Netherlands who wasn’t involved in the study.
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.
Total costs and patients’ out-of-pocket costs will also vary based on the type of insurance benefits they have, Dr. Oldenburg says.
There’s “almost nothing” IBD patients can do to lower their costs, Oldenburg adds.
“The only thing patients with Crohn's disease can do is stop smoking, because this will reduce the risk of flares of the disease, the number of hospitalizations, and the number of surgeries,” Oldenburg notes. “And, if patients have to come in for regular infusions, a switch to self-administered injections can be made to potentially lower costs.”