Abstract INTRODUCTION Inflammatory bowel diseases (IBD) are gastrointestinal (GI) conditions characterized by chronic inflammation of the digestive tract, which are associated with significant costs. Traditionally, research has focused on the overall costs of a disease per calendar year, however examining the cost of a specific illness-related index event and the surrounding episode of care may provide a more representative estimate of the costs of care and identify opportunities for targeted value-based interventions. METHODS We conducted a cohort study using data from IBM Watson, a claims-based database covering millions of commercially insured individuals. We identified adult patients aged 18 to 65 years with encounters associated with a primary or secondary diagnosis of IBD from 01/01/2018 to 12/31/2019 based on ICD-10 codes. We defined an episode of care as 360 days of continuous care (90 days prior to the index event to 270 days after such event) around an emergency room (ER) visit, gastroenterologist visit, and non-gastroenterologist GI visit (which could include a visit to a PCP, rheumatologist, dietician, and other services attributable to IBD symptoms). Measures of cost and utilization were calculated as a per member mean over 360 days. RESULTS 105,496 IBD patients with 1 year of continuous enrollment between 01/01/2019 to 12/31/2019 (calendar year cohort) and 81,774 patients with 2 years of continuous enrollment between 1/1/2018-12/31/2019 (episode of care cohort) were identified. Among IBD patients identified in the episode of care cohort, 13,164 (16.1%) patients had an IBD-related ER visit, 42,001 (51.4%) patients had a gastroenterologist visit, and 28,699 (35.1%) patients had a non-gastroenterologist GI visit. The mean per member calendar year total cost and GI-related costs were $40,842 and $31,051 respectively, compared to $68,0565 and $54,060 for an ER episode, $42,915 and $34,870 for gastroenterologist visit episode, and $48,556 and $38,120 for a non-gastroenterologist GI visit episode. Per member GI inpatient admissions (0.84), GI ER visits (1.98), GI-tests (5.90), and GI-imaging (0.91) were highest in the ER episode of care. Per member gastroenterologist visits (2.20), GI-related medication administration services (1.22) and biologic medication (1.41) were highest in the gastroenterologist episode of care. Per member non-gastroenterologist GI visits (4.50), and non-biologic GI medications (8.26) were highest in the non-gastroenterologist GI visits episode of care (Table 1 and 2). CONCLUSION This study found large variations in costs and utilization when looking at IBD- specific episodes of care. This episode-centered approach provides insights for developing targeted strategies to identify and intervene at the critical moments when patients seek advanced care, which may lead to patient-centered and cost-efficient healthcare delivery.
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