Direct and indirect healthcare resource utilization and costs associated with ulcerative colitis in a privately-insured employed population in the US

Abstract

Objective:

To assess direct and indirect healthcare resource utilization and costs of privately insured US employees with ulcerative colitis (UC) from a societal perspective.

Research design and methods:

Employees aged 18–64 with ≥2 UC diagnoses and no more than one diagnosis of Crohn’s disease (CD) were identified from a large, de-identified, private insurance US claims database from January 1, 2005 through March 31, 2013. Patients with UC were matched 1:1 to non-IBD controls based on demographics and index date (a randomly selected UC diagnosis). All patients were required to have continuous eligibility for ≥1 year before (baseline period) and after (study period) the index date. Descriptive analyses compared baseline characteristics and study period outcomes. Multivariate cost analysis adjusted for baseline comorbidities. Sub-group analyses compared patients with moderate-to-severe UC with matched controls.

Main outcome measures:

Costs (2013 US dollars) were measured from a societal perspective, which included direct (patient and payer costs) and indirect (lost wages because of time away from work) costs.

Results:

Patients with UC (n = 4314; mean age = 45.1 years, 63.6% male) had significantly higher baseline comorbidity rates compared with controls. In the study period, significantly more patients with UC (p < 0.0001) had higher hospitalization rates (16.9% vs 6.2%), emergency department visits (31.1% vs 22.0%), prescription drug use (95.3% vs 72.0%), and work loss (100% vs 81.4%). Patients with UC also had significantly higher adjusted total direct ($15,548 vs $4812) and indirect costs ($4125 vs $1961). Patients with moderate-to-severe UC (n = 1728) had significantly (p < 0.0001) higher hospitalization rates (26.5% vs 6.2%) and adjusted total direct ($23,085 vs $4932) and indirect costs ($5666 vs $1960).

Conclusions:

Patients with UC had higher resource utilization and direct and indirect costs compared with matched controls. The excess burden was greatest in patients with moderate-to-severe UC.

Keywords::

• Colitis
• Ulcerative
• Economics
• Cost of illness
• Healthcare costs
• Health expenditures
• Absenteeism

Transparency

Declaration of funding

Design, study conduct, and financial support for the study were provided by AbbVie; AbbVie participated in the interpretation of data, review, and approval of the publication.

Declaration of financial/other relationships

RC has served as a consultant and on scientific advisory boards for AbbVie, Celgene, Entera Health, Hospira, Janssen, Prometheus, Salix, Sandoz, Shire, Takeda, and UCB Pharma. He has served on speaker’s bureau for AbbVie, Entera Health, Salix, and Shire. MY is an employee of Analysis Group, Inc., which received consulting fees from AbbVie for this research. At the time of this study MD was an employee of Analysis Group, Inc., which received consulting fees from AbbVie for this research. JC, ABO, and MS are employed at AbbVie and may hold stock in AbbVie. At the time of this study JR was an employee of AbbVie and may hold stock in AbbVie.

Acknowledgments

Editorial services were provided by Joann Hettasch, PhD, of Arbor Communications, Inc., Ann Arbor, MI, and funded by AbbVie. The authors would like to acknowledge Jin Wei, an employee of Analysis Group, Inc., for her contribution to this research. Results of an earlier analysis of the same database were presented in part at the American College of Gastroenterology Annual Scientific Meeting, October 19–24, 2012, Las Vegas, Nevada; and Advances in Inflammatory Bowel Diseases: Crohn’s & Colitis Foundation’s Clinical & Research Conference, December 13–15, 2012, Hollywood, Florida.