Direct and indirect healthcare resource utilization and costs associated with ulcerative colitis in a privately-insured employed population in the US

Objective: To assess direct and indirect healthcare resource utilization and costs of privately insured US employees with ulcerative colitis (UC) from a societal perspective. Research design and methods: Employees aged 18-64 with >= 2 UC diagnoses and no more than one diagnosis of Crohn's disease (CD) were identified from a large, de-identified, private insurance US claims database from January 1, 2005 through March 31, 2013. Patients with UC were matched 1:1 to non-IBD controls based on demographics and index date (a randomly selected UC diagnosis). All patients were required to have continuous eligibility for >= 1 year before (baseline period) and after (study period) the index date. Descriptive analyses compared baseline characteristics and study period outcomes. Multivariate cost analysis adjusted for baseline comorbidities. Sub-group analyses compared patients with moderate-to-severe UC with matched controls. Main outcome measures: Costs (2013 US dollars) were measured from a societal perspective, which included direct (patient and payer costs) and indirect (lost wages because of time away from work) costs. Results: Patients with UC (n = 4314; mean age = 45.1 years, 63.6% male) had significantly higher baseline comorbidity rates compared with controls. In the study period, significantly more patients with UC (p<0.0001) had higher hospitalization rates (16.9% vs 6.2%), emergency department visits (31.1% vs 22.0%), prescription drug use (95.3% vs 72.0%), and work loss (100% vs 81.4%). Patients with UC also had significantly higher adjusted total direct ($15,548 vs $4812) and indirect costs ($4125 vs $1961). Patients with moderate-to-severe UC (n = 1728) had significantly (p50.0001) higher hospitalization rates (26.5% vs 6.2%) and adjusted total direct ($23,085 vs $4932) and indirect costs ($5666 vs $1960). Conclusions: Patients with UC had higher resource utilization and direct and indirect costs compared with matched controls. The excess burden was greatest in patients with moderate-to-severe UC.