OBJECTIVES : Aim 1, Determine medical services attributable costs and healthcare utilization (ED visits, hospitalizations and surgeries) within 18 months of diagnosis of Crohn's disease (CD) among propensity score matched publicly and privately insured children. Aim 2, Determine differences in access to biologic therapies within cohorts of publicly and privately insured children with newly diagnosed CD.

METHODS

: Medicaid and Commercial (private) Insurance databases were used for this analysis. We identified children with the diagnosis of CD and classified by payer type. Healthcare utilization and patent clinical characteristics were examined for the 6-month pre-index “look back” period for comorbidity assessment and outcomes including receipt of biologic, time to biologic and ED and hospitalization rates were examined during an 18 month post-index period. Sensitivity analysis were performed using inverse probability of treatment weighting (Propensity score weighting, PS) including all demographic and clinical characteristics described during the baseline 6-month look-back period.

RESULTS

: 6163 children with CD, 5518 were privately insured (PI) children and 645 children had Medicaid fee-for-service. There were no significant differences between each group’s baseline characteristics and co-morbidities. Patients on Medicaid, averaged 1.8 ED visits (SD: 3.6) in 18-month post-index period vs 0.8 (SD: 2.2) ED visits per PI patient (p value=.01). On average PI subjects had 0.3 (SD: 1.0) admissions per subject compared to 0.5 (SD 1.1) for children on Medicaid (p value=.01). Compared with the PI group, the adjusted hazard of receiving a biologic at any time within 18 month of diagnosis was 39% higher in the Medicaid population (p value=.0004).

CONCLUSIONS

Healthcare utilization is higher for children covered under Medicaid in the USA. This is unrelated to disease severity or risk of complications compared to PI patients with CD. Larger thinking on care delivery models is required to resolve these issues for CD and other chronic health conditions affecting children in the USA.