Long-term evolution of direct healthcare costs for inflammatory bowel diseases: a population-based study (2006–2015)

Abstract

Introduction: We explored the long-term evolution of direct healthcare costs for inflammatory bowel diseases (IBD) using a population-level database in a country with an escalating burden of IBD.

Methods: We searched the database of the Korean National Health Insurance Claims, which covers more than 97% of the South Korean population. An IBD diagnosis was defined as the combination of a billing code for Crohn’s disease (CD: K50.xx) or ulcerative colitis (UC: K51.xx) and at least one claim for IBD-specific drugs. Between 2006 and 2015, a total of 59,447 patients (CD: 17,677; UC: 41,770) were included.

Results: The total and mean cost per capita increased significantly over time. In the last year of the study (2015), the cost for anti-tumor necrosis factor (TNF) therapy accounted for 68.8% (CD) and 48.8% (UC) of the total cost. Age at diagnosis (<20 years vs. ≥30 years) and anti-TNF use were independent predictors of increased total IBD cost. Anti-TNF therapy was the strongest predictor of high-cost outliers (designated as the top 20 percentile of the total costs) for IBD (OR: 160.4; 95% CI: 89.0–289.2). The mean cost among patients with newly diagnosed CD increased significantly over the 8-year follow-up period (p = .03), while costs associated with UC remained stable. Only medication costs increased significantly during the follow-up period for CD.

Conclusions: Over the past 10 years, the increased usage of anti-TNF agents has been the key driver of IBD-related healthcare costs. Long-term cost-cutting strategies for patients with CD are warranted.

Keywords:

• Anti-tumor necrosis factor-alpha
• cost and cost analysis
• delivery of health care
• inflammatory bowel diseases

Acknowledgments

This study used the National Health Insurance Service (NHIS) National Health Information Database (NHIS-2018-4-022). The authors declare no conflict of interest with the NHIS. The manuscript, including related data, figures and tables has not been previously published and that the manuscript is not under consideration elsewhere.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Big Data Research Fund by The Korean Society of Gastroenterology. This work was supported by a grant from Kyung Hee University in 2018 [KHU-20181072]. The study sponsors have no contribution in the study design, analysis, interpretation of data and publication.