Economic Burden Associated with Strictures and/or Fistulae Among Commercially Insured Patients Diagnosed with Crohn?s Disease in the US
Author(s)
Fan Y1, Jimenez M2, Zhang L1, Bohn R2, Thompson J3, Brodovicz KG4, Gray S2, Melmed G5
1Boehringer Ingelheim, Ingelheim, CT, Germany, 2Bohn Epidemiology, Boston, MA, USA, 3Boehringer Ingelheim, Ridgefield, CT, USA, 4Boehringer Ingelheim International GmbH, Ridgefield, CT, USA, 5Cedars-Sinai Medical Center, Los Angeles, CA, USA
OBJECTIVES Crohn’s disease (CD) is a chronic and progressive immune-mediated gastrointestinal condition that can progress to stricturing or fistulizing complications. This study aims to quantify burden of illness related to strictures and/or fistulae in patients with CD. METHODS Using the Optum Research Database from 10/2015 to 12/2019, patients diagnosed with CD and fistula and/or stricture were selected into “condition cohorts”: CD/fistula, CD/stricture, and CD/fistula+stricture. Patients diagnosed with CD but no fistula or stricture were used as “comparators” and matched 1:1 by age, gender, and region to each condition cohort. Post-diagnosis per-patient per-year (PPPY) healthcare resource utilization (HRU) and costs were assessed accounting for variable length of follow-up period. Univariate Poisson or generalized linear models (GLMs) were used to compare HRU and costs between each condition and comparator cohorts, respectively. Multivariable GLMs were constructed to assess the association of fistulae and/or strictures with the total cost. RESULTS The CD/fistula, CD/stricture, and CD/fistula+stricture cohorts included 1,317, 4,650, and 894 patients, respectively. The CD/stricture cohort were older than the other two cohorts (mean age=60 vs. 50 years). Relative to comparators, condition cohorts had similar baseline comorbidity profiles except for colon cancer, bowel perforation and abscess (prevalence higher in CD/fistula and CD/fistula+stricture). Condition cohorts had 2-4 times more inpatient visits, 5-10 times more surgical visits, and 2-3 times more endoscopies PPPY than comparators. Comparing condition cohorts (CD/fistula, CD/stricture, CD/fistula+stricture, respectively) with comparators, inpatient costs were $61,412 (vs. $23,167), $92,235 (vs. $17,977), and $112,654 (vs. $23,273) PPPY; total costs were $121,268 (vs. $64,545), $139,739 (vs. $55,482), and $188,907 (vs. $65,931) PPPY with adjusted total cost ratios of 2.0, 2.5, and 2.1, respectively. P values <0.01 for all comparisons. CONCLUSIONS This study demonstrates a significant economic burden related to fistulae or/and strictures among patients with CD, highlighting the importance of prevention, early recognition and management of complications in CD.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Code
PGI13
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Clinical Outcomes Assessment
Disease
Gastrointestinal Disorders