S2701 Economic Costs and Trends in Inflammatory Bowel Disease-Related Hospitalizations and Surgery in the United States

Abstract

Introduction: Limited data are available on hospitalization, surgery, and cost trends over time in patients with Crohn’s disease (CD) and ulcerative colitis (UC) in the United States. This analysis describes real-world trends in hospitalizations, surgery, and costs among patients with CD and UC. Case Description/Methods: Data from patients with CD and UC in the IBM MarketScan Databases (2007–2019) were evaluated. Eligible patients for each year had to have ≥1 inpatient claim or 2 outpatient claims for either CD or UC within that year and medical benefits for the entire year. For hospitalizations, an encounter group algorithm for all inpatient claims was utilized to determine the principal diagnosis and duration of each hospital episode. The surgery encounter was defined as either a hospitalization with a CD/UC-related surgery procedure code (principal procedure type) with a CD or UC diagnosis code in the first 2 diagnosis positions of the hospital encounter or an outpatient visit. Proportions of CD and UC patients with ≥1 hospitalization or surgery, the average cost per surgery or hospitalization episode, and mean length of stay (LOS) in days were reported for each year. Costs were adjusted to 2020 US dollars. Over time, prevalence of hospitalizations decreased from 11.8% and 7.7% in 2007 to 7.1% and 4.8% in 2019 in patients with CD and UC, respectively ( Figurea). The annual proportion of patients with a CD/UC-related surgery decreased from 2.3% and 1.2% in 2007 to 1.6% and 0.9% in 2019 in patients with CD and UC, respectively. Conversely, mean medical costs per CD/UC hospitalization episode increased from $22,346/$23,002 in 2007 to $28,586/$28,069 in 2019 (Figureb). Additionally, mean medical costs per CD/UC surgery increased from $41,300 and $47,286 in 2007 to $55,870 and $61,698 in 2019. In patients with CD and UC, the average LOS per hospitalization reduced from 5.8 and 6.6 days in 2007 to 4.6 and 5.6 days in 2019. Discussion: Despite a decrease in CD- and UC-related hospitalizations and surgery from 2007 to 2019, as well as reduced mean LOS, the average cost per hospitalization and surgery increased. Additional research is warranted to better understand these trends so that medical costs can be further reduced and management of patients in the outpatient setting can be improved.Figure 1.: Prevalence of (a) Hospitalization and Surgery and (b) Mean Costs by Year *Includes all associated costs except medication costs. CD, Crohn’s disease; K, thousand; UC, ulcerative colitis.