4.5 Article

Trends in US Health Care Spending on Inflammatory Bowel Diseases, 1996-2016

Journal

INFLAMMATORY BOWEL DISEASES
Volume 28, Issue 3, Pages 364-372

Publisher

OXFORD UNIV PRESS INC
DOI: 10.1093/ibd/izab074

Keywords

costs; expenses; value-based care; Crohn disease; colitis

Funding

  1. National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [T32DK007202, K23DK117058]
  2. National Institutes of Health/National Library of Medicine [T15LM011271]
  3. NIDDK [P30 DK120515]
  4. International Organization for the Study of Inflammatory Bowel Diseases Operating Grant 2019
  5. American College of Gastroenterology Junior Faculty Development Award [144271]

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Despite the rising prevalence of IBD, healthcare spending on IBD patients in the United States has significantly increased from 1996 to 2016, primarily in middle-aged and older adults. Inpatient and emergency department services accounted for the majority of costs during this period.
Background Inflammatory bowel diseases (IBD) are rising in prevalence and are associated with high health care costs. We estimated trends in U.S. health care spending in patients with IBD between 1996 and 2016. Methods We used data on national health care spending developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project. We estimated corresponding U.S. age-specific prevalence of IBD from the Global Burden of Diseases Study. From these 2 sources, we estimated prevalence-adjusted, temporal trends in U.S. health care spending in patients with IBD, stratified by age groups (<20 years, 20-44 years, 45-64 years, >= 65 years) and by type of care (ambulatory, inpatient, emergency department [ED], pharmaceutical prescriptions, and nursing care), using joinpoint regression, expressed as an annual percentage change (APC) with 95% confidence intervals. Results Overall, annual U.S. health care spending on IBD increased from $6.4 billion (95% confidence interval, 5.7-7.4) in 1996 to $25.4 billion (95% confidence interval, 22.4-28.7) in 2016, corresponding to a per patient increase in annual spending from $5714 to $14,033. Substantial increases in per patient spending on IBD were observed in patients aged >= 45 years. Between 2011 and 2016, inpatient and ED care accounted for 55.8% of total spending and pharmaceuticals accounted for 19.9%, with variation across age groups (inpatient/ED vs pharmaceuticals: ages >= 65 years, 57.6% vs 11.2%; ages 45-64 years, 49.5% vs 26.9%; ages 20-44 years, 59.2% vs 23.6%). Conclusions Even after adjusting for rising prevalence, U.S. health care spending on IBD continues to progressively increase, primarily in middle-aged and older adults, with unplanned health care utilization accounting for the majority of costs.

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