Assessing Direct and Indirect Costs in Ulcerative Colitis

Abstract

Purpose: To advance understanding of the cost drivers associated with UC and benchmark the impact on a large self-insured provider. Methods: Claimant records for a retrospective cohort of pts with UC (ICD-9 code 556.x) from a database of a self-insured employer, consisting of approx. 500000 employees, retirees, or dependents from 2002 to 2004 were analyzed to determine costs attributed to direct utilization and short-term disability (STD). 18 months of continuous enrollment was required [6-month pre and 12 months post-index date]. A randomly selected, age and gender matched control group, of non-UC claimants was the comparator. Individual claimants (UC and Controls) with costs ≥ 3 SDs from the overall mean were excluded on a basis of outlier status (N = 13, n = 50). Multiple linear regression technique was used to determine the predictors of cost, adjusting for CMS-HCC scores. A disease severity stratification algorithm classified UC pts into 3 mutually exclusive cohorts, mild [untreated or treated with aminosalicylates or topical therapy]; moderate [additional therapies (e.g., oral corticosteroids, immunomodulators)]; or severe [requiring hospitalization for UC] cohort. Results: Healthcare costs were evaluated for 1044 UC pts. Mean annual unadjusted total costs for all UC pts were $12120 vs $5128 for the non-UC group (N = 4178). The regression model indicated UC was a predictor of higher costs vs the control group (coefficient = 5136.37, p < 0.005). When stratified by disease severity, the severe UC cohort had 79.6% higher mean total costs vs the moderate group ($21999 vs $12248) and the moderate UC cohort had a 24.3% higher mean total costs vs the mild group ($12248 vs $9847). After adjustment for CMS-HCC scores in the regression analysis, the severe group was a significant predictor of increased cost, vs the mild and moderate pts (coefficient = 5847.84, p= 0.03). Additionally indirect costs for 211 (19.96%) UC pts filed claims for disability dispensation, with a mean payment of $2366. Conclusions: Utilization expenditures for the UC cohort were over 2 times more costly vs pts without UC. Healthcare costs were highest for pts with severe UC. These results highlight the impact of UC healthcare expenditures on a self-insured employer. Increased awareness and attention to UC is warranted.