Direct Health Care Insurer and Out-of-Pocket Expenditures of Inflammatory Bowel Disease: Evidence from a US National Survey
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Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, debilitating conditions that can have important economic and clinical implications.
To quantify individual and national estimates of the health care and patient out-of-pocket (OOP) costs of CD and UC.
In a retrospective study using 1996 to 2009 data from the Medical Expenditure Panel Survey, individuals’ self-reported health conditions were mapped to International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Individuals with a code of 555.x (CD) or 556.x (UC) were identified. Health care services and costs included prescriptions and inpatient, outpatient, emergency room, office, and home health services. OOP costs were the portion of individuals’ total payments for health care services.
There were 358 individuals with CD (mean age 49.0 years; 55 % female), 198 individuals with UC (mean age 47.1 years; 64 % female), and 206,993 individuals without inflammatory bowel disease (IBD) (mean age 48.2 years; 58 % female). Annual per capita health insurer and OOP costs for individuals with CD were greater than those without IBD ($9,526 versus $3,781, p < 0.001 and $1,603 versus $866, p < 0.001, respectively). Health insurer and OOP costs were greater for UC compared with those without IBD ($6,443 versus $3,781, p < 0.001 and $1,263 versus $866, p < 0.001, respectively). US national aggregate annual estimates of health insurer, OOP, and total direct costs secondary to CD are $2.04 billion, $0.26 billion, and $2.29 billion, respectively. Aggregate health insurer, OOP, and total direct costs attributable to UC are $0.53 billion, $0.07 billion, and $0.61 billion, respectively.
The direct costs associated with CD and UC are substantial. The extent to which appropriate diagnosis and treatment reduces the total health care costs for individuals with CD or UC should be examined.
- Kappelman, MD, Rifas-Shiman, SL, Kleinman, K (2007) The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 5: pp. 1424-1429 CrossRef
- Loftus, EV, Schoenfeld, P, Sandborn, WJ (2002) The epidemiology and natural history of Crohn’s disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther 16: pp. 51-60 CrossRef
- Sonnenberg, A, McCarty, DJ, Jacobsen, SJ (1991) Geographic variation of inflammatory bowel disease within the United States. Gastroenterology 100: pp. 143-149
- Shivananda, S, Lennard-Jones, J, Logan, R (1996) Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 39: pp. 690-697 CrossRef
- Calkins, BM, Lilienfeld, AM, Garland, CF, Mendeloff, AI (1984) Trends in incidence rates of ulcerative colitis and Crohn’s disease. Dig Dis Sci 29: pp. 913-920 CrossRef
- Stowe, SP, Redmond, SR, Stormont, JM (1990) An epidemiologic study of inflammatory bowel disease in Rochester, New York. Hospital incidence. Gastroenterology 98: pp. 104-110
- Roth, MP, Petersen, GM, McElree, C, Feldman, E, Rotter, JI (1989) Geographic origins of Jewish patients with inflammatory bowel disease. Gastroenterology 97: pp. 900-904
- Kornbluth, A, Sachar, DB (2004) Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 99: pp. 1371-1385 CrossRef
- Lichtenstein GR, Hanauer SB, Sandborn WJ, Practice Parameters Committee of the American College of Gastroenterology. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104:465–483.
- Cohen, JL, Strong, SA, Hyman, NH (2005) Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 48: pp. 1997-2009 CrossRef
- Greenstein, AJ, Janowitz, HD, Sachar, DB (1976) The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore) 55: pp. 401-412 CrossRef
- Barreiro-de Acosta, M, Domínguez-Muñoz, JE, Núñez-Pardo de Vera, MC, Lozano-León, A, Lorenzo, A, Peña, S (2007) Relationship between clinical features of Crohn’s disease and the risk of developing extraintestinal manifestations. Eur J Gastroenterol Hepatol 19: pp. 73-78 CrossRef
- Joo, M, Abreu-e-Lima, P, Farraye, F (2009) Pathologic features of ulcerative colitis in patients with primary sclerosing cholangitis: a case-control study. Am J Surg Pathol 33: pp. 854-862 CrossRef
- Bernstein, CN, Blanchard, JF, Houston, DS, Wajda, A (2001) The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost 85: pp. 430-434
- Solem, CA, Loftus, EV, Tremaine, WJ, Sandborn, WJ (2004) Venous thromboembolism in inflammatory bowel disease. Am J Gastroenterol 99: pp. 97-101 CrossRef
- Choi, PM, Zelig, MP (1994) Similarity of colorectal cancer in Crohn’s disease and ulcerative colitis: implications for carcinogenesis and prevention. Gut 35: pp. 950-954 CrossRef
- Bernstein, CN, Papineau, N, Zajaczkowski, J, Rawsthorne, P, Okrusko, G, Blanchard, JF (2000) Direct hospital costs for patients with inflammatory bowel disease in a Canadian tertiary care university hospital. Am J Gastroenterol 95: pp. 677-683 CrossRef
- Hillson, E, Dybicz, S, Waters, HC (2008) Health care expenditures in ulcerative colitis: the perspective of a self-insured employer. J Occup Environ Med 50: pp. 969-977 CrossRef
- Kappelman, MD, Rifas-Shiman, SL, Porter, CQ (2008) Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology 135: pp. 1907-1913 CrossRef
- Gibson, TB, Ng, E, Ozminkowski, RJ (2008) The direct and indirect cost burden of Crohn’s disease and ulcerative colitis. J Occup Environ Med 50: pp. 1261-1272 CrossRef
- Cohen, RD, Larson, LR, Roth, JM, Becker, RV, Mummert, LL (2000) The cost of hospitalization in Crohn’s disease. Am J Gastroenterol 95: pp. 524-530 CrossRef
- Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. Survey Background. Agency for Healthcare Research and Quality Web site. Available at: http://www.meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp. Accessed March 12, 2009.
- Cohen JW, Monheit AC, Beauregard KM, et al. The Medical Expenditure Panel Survey: a national health information resource. Inquiry. 1996–1997;33:373–389.
- Cohen SB, DiGaetano R, Goksel H. Methodology Report #5: Estimation Procedures in the 1996 MEPS Household Component. Agency for Healthcare Research and Quality Web site. Available at: http://meps.ahrq.gov/mepsweb/data_files/publications/mr5/mr5.shtml. Published May 1999. Accessed March 12, 2010.
- Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. MEPS-HC Response Rates by Panel. Agency for Healthcare Research and Quality Web site. Available at: http://meps.ahrq.gov/mepsweb/survey_comp/hc_response_rate.jsp. Accessed February 10, 2010.
- Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. MEPS Expenditures. MEPS-HC Summary Data Tables Technical Notes. Agency for Healthcare Research and Quality Web site. Available at: http://meps.ahrq.gov/mepsweb/survey_comp/hc_technical_notes.shtml#expenditures. Published May 2004. Accessed April 18, 2012.
- Lee, DW, Meyer, JW, Clouse, J (2001) Implications of controlling for comorbid conditions in cost-of-illness estimates: a case study of osteoarthritis from a managed care system perspective. Value Health 4: pp. 329-334
- Cragg, JG (1971) Some statistical models for limited dependent variables with application to the demand for durable goods. Econometrica 39: pp. 829-844 CrossRef
- Buntin, MB, Zaslavsky, AM (2004) Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. J Health Econ 23: pp. 525-542 CrossRef
- Mullahy, J (1998) Much ado about two: reconsidering retransformation and the two-part model in health econometrics. J Health Econ 17: pp. 247-281 CrossRef
- Kotlarz, H, Gunnarsson, CL, Fang, H, Rizzo, JA (2009) Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum 60: pp. 3546-3553 CrossRef
- United States Census Bureau. Table HI01. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: 2010 All Races. United States Census Bureau Web site. Available at: http://www.census.gov/hhes/www/cpstables/032011/health/h01_001.htm. Accessed March 2, 2010.
- Shanahan, F, Bernstein, CN (2009) The evolving epidemiology of inflammatory bowel disease. Curr Opin Gastroenterol 25: pp. 301-305 CrossRef
- US Department of Health and Human Services, Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. Centers for Disease Control and Prevention Web site. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Accessed January 31, 2010.
- National Heart, Lung and Blood Institute. Incidence and Prevalence: 2006 Chart Book on Cardiovascular and Lung Diseases. National Heart, Lung, and Blood Institute Web site. Available at: http://www.nhlbi.nih.gov/resources/docs/06a_ip_chtbk.pdf. Published May 2006. Accessed April 6, 2008.
- US Bureau of Labor Statistics. National Compensation Survey: Occupational Wages in the United States, July 2003. (Bulletin 2568). US Bureau of Labor Statistics Web site. Available at: http://stats.bls.gov/ncs/ocs/sp/ncbl0658.pdf. Published September 2004. Accessed February 10, 2010.
- Blumenthal, D (2006) Employer-sponsored insurance—riding the health care tiger. N Engl J Med 355: pp. 195-202 CrossRef
- Blumenthal, D (2006) Employer-sponsored health insurance in the United States—origins and implications. N Engl J Med 355: pp. 82-88 CrossRef
- Collins, SR, Davis, K, Ho, A (2005) A shared responsibility: US employers and the provision of health insurance to employees. Inquiry 42: pp. 6-15 CrossRef
- Machlin, S, Cohen, J, Elixhauser, A, Beauregard, K, Steiner, C (2009) Sensitivity of household reported medical conditions in the Medical Expenditure Panel Survey. Med Care 47: pp. 618-625 CrossRef
- Direct Health Care Insurer and Out-of-Pocket Expenditures of Inflammatory Bowel Disease: Evidence from a US National Survey
Digestive Diseases and Sciences
Volume 57, Issue 12 , pp 3080-3091
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Costs and cost analysis
- Crohn’s disease
- Health care costs
- Health expenditures
- Inflammatory bowel disease
- Ulcerative colitis
- Industry Sectors
- Author Affiliations
- 1. S2 Statistical Solutions, Inc., 11176 Main Street, Cincinnati, OH, 45241, USA
- 2. Department of Political Science, Economics, and Philosophy, College of Staten Island, CUNY, 2N-229, 2800 Victory Boulevard, Staten Island, NY, 10314, USA
- 8. Department of Health Services Administration, School of Public Health, University of Maryland, 3310A School of Public Health Building, College Park, MD, 20742, USA
- 3. Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
- 4. Department of Economics, Stony Brook University, Stony Brook, NY, 11794, USA
- 5. Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- 6. Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
- 9. Department of Population Medicine, New York University, 550 1st Avenue, VZ30 6th Floor, New York, NY, 10012, USA
- 7. Janssen Scientific Affairs, LLC, 850 Ridgeview Drive, Horsham, PA, 19044, USA