Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Michelle D Park, Jay Bhattacharya, Kt Park, Michelle D Park, Jay Bhattacharya, Kt Park

Abstract

Background. Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD). Aim. To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US). Methods. We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn's disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures. Results. Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N = 238), $7,827 (N = 95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N = 276, 372, p < 0.05). Publicly insured patients incurred the highest costs ($18,067) over privately insured ($8,014, p < 0.05) or uninsured patients ($5,129, p < 0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p < 0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI [1.08-4.19]) or no insurance (OR 4.94, CI [1.26-19.47]), with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI [0.15-0.95]) and office-based care (OR 0.21, CI [0.07-0.62]). Conclusions. In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.

Keywords: Crohn’s disease; Health insurance; Socioeconomic factors; Ulcerative colitis.

Figures

Figure 1. Distribution of annual per capita…
Figure 1. Distribution of annual per capita mean expenditures across various categories.
IBD patients unless specified non-IBD. Dark gray: total expenditures. Light gray: mutually exclusive clinical care settings. Error bars are 95% confidence intervals.
Figure 2. Distribution of annual per capita/Odds…
Figure 2. Distribution of annual per capita/Odds of IBD expenditures.
(A) Distribution of annual per capita mean expenditures for IBD patients across various categories, by insurance status. Error bars are 95% confidence intervals. (B) Odds of IBD expenditures above the mean for the respective setting of clinical care, between two insurance status groups. Adjusted for age, sex, race/ethnicity, and comorbidities. ∗ p < 0.05,

References

    1. Agency for Healthcare Research and Quality 2009. MEPS topics: office-based visits/use/events and expenditures. Available at .
    1. Agency for Healthcare Research and Quality 2010. MEPS HC-120: 2008 Medical Conditions. Available at: .
    1. Agency for Healthcare Research and Quality 2013a. MEPS-HC response rates by panel. Available at: .
    1. Agency for Healthcare Research and Quality 2013b. MEPS-HC summary data tables technical notes. Available at .
    1. Andrulis DP. Access to care is the centerpiece in the elimination of socioeconomic disparities in health. Annals of Internal Medicine. 1998;129(5):412–416. doi: 10.7326/0003-4819-129-5-199809010-00012.
    1. Asplin BR, Rhodes KV, Levy H, Lurie N, Crain AL, Carlin BP, Kellermann AL. Insurance status and access to urgent ambulatory care follow-up appointments. JAMA. 2005;294(10):1248–1254. doi: 10.1001/jama.294.10.1248.
    1. Basu D, Lopez I, Kulkarni A, Sellin JH. Impact of race and ethnicity on inflammatory bowel disease. The American Journal of Gastroenterology. 2005;100(10):2254–2261. doi: 10.1111/j.1572-0241.2005.00233.x.
    1. Benchimol EI, To T, Griffiths AM, Rabeneck L, Guttmann A. Outcomes of pediatric inflammatory bowel disease: socioeconomic status disparity in a universal-access healthcare system. The Journal of Pediatrics. 2011;158(6):960–967. doi: 10.1016/j.jpeds.2010.11.039.
    1. Flasar MH, Johnson T, Roghmann M-C, Cross RK. Disparities in the use of immunomodulators and biologics for the treatment of inflammatory bowel disease: a retrospective cohort study. Inflammatory Bowel Diseases. 2008;14(1):13–19. doi: 10.1002/ibd.20298.
    1. Greenstein AJ, Romanoff AM, Moskowitz AJ, Sosunov EA, Khaitov S, Egorova NN. Payer status and access to laparoscopic subtotal colectomy for ulcerative colitis. Diseases of the Colon and Rectum. 2013;56(9):1062–1067. doi: 10.1097/DCR.0b013e31829b2d30.
    1. Gunnarsson C, Chen J, Rizzo JA, Ladapo JA, Lofland JH. Direct health care insurer and out-of-pocket expenditures of inflammatory bowel disease: evidence from a US national survey. Digestive Diseases and Sciences. 2012;57(12):3080–3091. doi: 10.1007/s10620-012-2289-y.
    1. Jackson JF, Dhere T, Repaka A, Shaukat A, Sitaraman S. Crohn’s disease in an African-American population. American Journal of the Medical Sciences. 2008;336(5):389–392. doi: 10.1097/MAJ.0b013e31816a5c06.
    1. Kaplan GG, Panaccione R, Hubbard JN, Nguyen GC, Shaheen AAM, Ma C, Devlin SM, Leung Y, Myers RP. Inflammatory bowel disease patients who leave hospital against medical advice: predictors and temporal trends. Inflammatory Bowel Diseases. 2009;15(6):845–851. doi: 10.1002/ibd.20835.
    1. Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a commercially insured US population. Digestive Diseases and Sciences. 2013;58(2):519–525. doi: 10.1007/s10620-012-2371-5.
    1. Kappelman MD, Rifas–Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, Finkelstein JA. The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clinical Gastroenterology and Hepatology. 2007;5(12):1424–1429. doi: 10.1016/j.cgh.2007.07.012.
    1. Kappelman MD, Rifas-Shiman SL, Porter CQ, Ollendorf DA, Sandler RS, Galanko JA, Finkelstein JA. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135(6):1907–1913. doi: 10.1053/j.gastro.2008.09.012.
    1. Loftus EV, Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn’s disease in population-based patient cohorts from North America: a systematic review. Alimentary Pharmacology & Therapeutics. 2002;16(1):51–60. doi: 10.1046/j.1365-2036.2002.01140.x.
    1. Machlin S, Yu W, Zodet M. 2005. Computing standard errors for MEPS estimates [Internet]. Rockville, MD: Agency for Healthcare Research and Quality. Available at .
    1. Medicaid Access Study Group Access of Medicaid recipients to outpatient care. The New England Journal of Medicine. 1994;330(20):1426–1430. doi: 10.1056/NEJM199405193302007.
    1. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EL, Panaccione R, Ghosh S, Barkema HW, Kaplan GG. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46–54. doi: 10.1053/j.gastro.2011.10.001.
    1. Mukherjee B, Ou H-T, Wang F, Erickson SR. A new comorbidity index: the health-related quality of life comorbidity index. Journal of Clinical Epidemiology. 2011;64(3):309–319. doi: 10.1016/j.jclinepi.2010.01.025.
    1. Nahon S, Lahmek P, Macaigne G, Faurel JP, Sass C, Howaizi M, Fleury A, Baju A, Locher C, Barjonet G, Saillant G, Moulin JJ, Poupardin C. Socioeconomic deprivation does not influence the severity of Crohn’s disease: results of a prospective multicenter study. Inflammatory Bowel Diseases. 2009;15(4):594–598. doi: 10.1002/ibd.20794.
    1. Nguyen GC, Bayless TM, Powe NR, Laveist TA, Brant SR. Race and health insurance are predictors of hospitalized Crohn’s disease patients undergoing bowel resection. Inflammatory Bowel Diseases. 2007;13(11):1408–1416. doi: 10.1002/ibd.20200.
    1. Nguyen GC, LaVeist TA, Harris ML, Wang M-H, Datta LW, Brant SR. Racial disparities in utilization of specialist care and medications in inflammatory bowel disease. The American Journal of Gastroenterology. 2010;105(10):2202–2208. doi: 10.1038/ajg.2010.202.
    1. Nguyen GC, Torres EA, Regueiro M, Bromfield G, Bitton A, Stempak J, Dassopoulos T, Schumm P, Gregory FJ, Griffiths AM. Inflammatory bowel disease characteristics among African Americans, Hispanics, and non-Hispanic whites: characterization of a large North American cohort. The American Journal of Gastroenterology. 2006;101(5):1012–1023. doi: 10.1111/j.1572-0241.2006.00504.x.
    1. Ou H-T, Mukherjee B, Erickson SR, Piette JD, Bagozzi RP, Balkrishnan R. Comparative performance of comorbidity indices in predicting health care-related behaviors and outcomes among Medicaid enrollees with type 2 diabetes. Population Health Management. 2012;15(4):220–229. doi: 10.1089/pop.2011.0037.
    1. Sewell JL, Velayos FS. Systematic review: the role of race and socioeconomic factors on IBD healthcare delivery and effectiveness. Inflammatory Bowel Diseases. 2013;19(3):627–643. doi: 10.1002/ibd.22986.
    1. Sewell JL, Yee HF, Inadomi JM. Hospitalizations are increasing among minority patients with Crohn’s disease and ulcerative colitis. Inflammatory Bowel Diseases. 2010;16(2):204–207. doi: 10.1002/ibd.21008.
    1. Stone CD. The economic burden of inflammatory bowel disease: clear problem, unclear solution. Digestive Diseases and Sciences. 2012;57(12):3042–3044. doi: 10.1007/s10620-012-2417-8.
    1. Straus WL, Eisen GM, Sandler RS, Murray SC, Sessions JT. Crohn’s disease: does race matter? The American Journal of Gastroenterology. 2000;95(2):479–483. doi: 10.1111/j.1572-0241.2000.t01-1-01531.x.
    1. Swoger JM, Binion DG. Supportive therapy in IBD: what additional diagnoses and conditions must be treated? Digestive Diseases. 2010;28(3):452–462. doi: 10.1159/000320402.

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