Abstract
BackgroundEnd of life (EOL) care is associated with greater costs, particularly for acute care services. In patients with inflammatory bowel disease (IBD), EOL costs may be accentuated due to reliance on hospital-based services and expensive diagnostic tests and treatments. We aimed to compare EOL health care use and costs between IBD and non-IBD decedents.MethodsWe conducted a retrospective cohort study of all decedents of Ontario, Canada between 2010 and 2013 using linked health administrative data. IBD (N = 2,214) and non-IBD (N = 262,540) decedents were compared on total direct health care costs in the last year of life and hospitalization time during the last 90 days of life.ResultsDuring the last 90 days of life, IBD patients spent an average of 16 days in hospital, equal to 2.1 greater adjusted hospital days (95% confidence interval [CI] 1.5–2.8 days) than non-IBD patients. IBD diagnosis was associated with $7,210 CAD (95% CI $5,005 - $9,464) higher adjusted per-patient cost in the last year of life, of which 76% was due to excess hospitalization costs. EOL cost of IBD care was higher than 15 of 16 studied chronic conditions. Health care costs rose sharply in the last 90 days of life, primarily due to escalating hospitalization costs.ConclusionsIBD patients spend more time in hospital and incur substantially greater health care costs than other decedents as they approach the EOL. These excess costs could be curtailed through avoidance of unnecessary hospitalizations and expensive treatments in the setting of irreversible deterioration.
Highlights
Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) that afflict 0.67% and 0.5% of the Canadian and U.S populations, respectively.[1;2] Patients with IBD experience substantial morbidity from their disease and use a considerable amount of health care resources.[2;3] Population-based studies estimate the direct annual health care costs of IBD at CAD 1.2 billion in Canada and $6.3 billion USD in the U.S.[2;4] Hospital admissions and medications account for the greatest burden of direct health care costs in IBD patients.[2;4,5,6]
Given the high cost of many newer drugs used to treat IBD and the frequent reliance on hospital-based care, it is conceivable that health care costs and acute care use at the EOL may be higher in IBD patients than in other decedents
To establish a benchmark for comparison, we evaluated mean health care costs in the last year of life among patients with 16 other complex chronic diseases and provide a breakdown of health care sector costs for patients with five conditions that are associated with high morbidity and mortality–cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes mellitus (DM) and renal disease
Summary
EOL health care use and costs have not been characterized in IBD patients. Given the high cost of many newer drugs used to treat IBD and the frequent reliance on hospital-based care, it is conceivable that health care costs and acute care use at the EOL may be higher in IBD patients than in other decedents. EOL care would constitute an important target for the development of cost-effective care strategies among IBD patients. We aimed to characterize EOL direct health care costs and health care utilization across sectors among IBD decedents, and to compare this to non-IBD decedents from the general population. In patients with inflammatory bowel disease (IBD), EOL costs may be accentuated due to reliance on hospital-based services and expensive diagnostic tests and treatments. We aimed to compare EOL health care use and costs between IBD and non-IBD decedents
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