Direct Health Care Costs of Crohn's Disease and Ulcerative Colitis in US Children and Adults

Abstract

Background Data regarding the health care costs of inflammatory bowel disease (IBD) in the United States are limited. Objectives 1) To estimate the direct costs of Crohn’s disease (CD) and ulcerative colitis (UC) in the U.S. 2) To describe the distribution of costs between inpatient, outpatient, and pharmaceutical services, and 3) To identify sociodemographic factors influencing these costs. Methods We extracted medical and pharmacy claims from an administrative database containing insurance claims from 87 health plans in 33 states, occurring between the years 2003–2004. We identified cases of CD and UC using an administrative definition. For each case, we selected up to 3 non-IBD controls. Claims were classified as inpatient, outpatient, or pharmaceutical according to Current Procedural Terminology or National Drug Codes. Costs were based on the paid amount of each claim. IBD-attributable costs were estimated by subtracting costs for non-IBD patients from those with IBD. Logistic regression was used to identify the sociodemographic factors affecting these costs. Results We identified 9,056 CD patients and 10,364 UC patients. Mean annual costs for CD and UC were $8265 and $5066 respectively. For CD, 31% of costs were attributable to hospitalization, 33% to outpatient care, and 35% to pharmaceutical claims. The corresponding distribution for UC was 38%, 35%, and 27% respectively. Costs were significantly higher for children age < 20, compared to adults, but did not vary substantially by gender or region. Discussion This study demonstrates a substantial economic burden of IBD and can be used to inform health policy.