Direct and Indirect Utilization and Costs Associated With Ulcerative Colitis

Abstract

To assess direct (medical services and prescription drugs) and indirect (work-loss) utilization and costs of privately insured US employees with ulcerative colitis (UC) and compare these outcomes with demographically matched controls without UC. Employees 18-64 years old with ≥2 UC diagnosis (dx) (ICD-9: 556.xx) were selected from Ingenix Employer Solutions databases from 1/1/2000 to 3/31/2010. Employees with Crohn's Disease (CD, ICD-9: 555.xx) were excluded. UC patients were matched to controls (employees without UC or CD) 1:1 on sex, age, region, and dx date (date of UC dx or other disease for controls). All patients had continuous eligibility for ≥1 year before (baseline period) and 1 year after (study period) the dx date. Direct costs (costs associated with hospitalization, emergency room visits, outpatient visits, and medication treatment) and indirect costs (lost wages from time away from work due to disability and medically-related absenteeism) were adjusted to 2010 US dollars (USD). Descriptive analyses compared baseline demographics, comorbidities, and direct/indirect utilizations/costs during the study period. A multivariate analysis compared costs adjusting for baseline comorbidities. These analyses were also performed for a subgroup of patients with moderate to severe UC (UC hospitalization or use of systemic corticosteroids, immunosuppressants, or biologics). 5157 employees with UC and 5157 matched controls (mean age, 48 years; 63.7% men) met the inclusion criteria. Employees with UC had significantly more baseline comorbidities including hypertension (21.1% vs. 17.3%, P<.0001), and higher Charlson comorbidity index scores (0.45 vs. 0.26, P < .0001) than did controls. Patients with moderate to severe UC (N = 1754) experienced significantly higher medical care usage (higher rates per year of hospitalization, emergency department, and prescription medication use and a greater number of hospitalization, disability, medically-related absenteeism, and outpatient visit days per year), and incurred higher total annual healthcare costs versus controls (Table). A wholegroup analysis revealed that, regardless of disease severity, UC patients experienced significantly higher medical care costs and utilization than controls (Table). Employed patients with UC had a higher use of medical resources and direct/indirect costs, especially those with moderate to severely active UC. Interventions targeting these sicker patients may have the greatest impact upon overall utilization and costs.