Assessment of corticosteroid-related quality of care measures for ulcerative colitis and Crohn’s disease in the United States: a claims data analysis

Abstract

Objective: To evaluate corticosteroid (CS)-related quality of care indicators in patients with ulcerative colitis (UC) and Crohn’s disease (CD) in the US.

Methods: Adults diagnosed with UC or CD and prescription fills for an oral CS were identified from a large commercial US claims database (2005–2013). Quality indicators included prolonged CS use (≥60 days), use of CS-sparing therapy, and bone loss assessment. State-level variations in quality of care indicators were estimated using logistic regression models adjusting for age, gender, insurance plan type, and CD severity.

Results: Of the 25,063 UC and 22,155 CD patients receiving CS, 16.1% and 12.6%, respectively, were prolonged CS users. Among prolonged CS users, 52.5% of UC and 68.2% of CD patients used CS-sparing therapy. Bone loss assessment was observed in 11.0% of UC patients with prolonged CS use and 7.7% of newly diagnosed CD patients. Prolonged CS use was the lowest in Kentucky (odds ratio [OR] = 0.59) and the highest in Wisconsin (OR = 1.41) for UC patients; the lowest in North Carolina and New York (both OR = 0.71) and the highest in Utah (OR = 2.42) for CD patients. CS-sparing therapy use was the lowest in Delaware (OR = 0.42) and the highest in Michigan (OR = 0.83) for UC patients; it was significantly different only in South Carolina (OR = 0.57) for CD patients. Bone loss assessment rates were the highest in Arizona (OR = 1.83) for UC patients and were the lowest in Mississippi (OR = 0.52) and the highest in Texas (OR = 1.51) for CD patients.

Limitations: Information on disease severity was not available in the database.

Conclusions: Significant regional variations in all three quality indicators were observed across the US.

Keywords:

• Corticosteroids
• Crohn’s disease
• quality indicators
• ulcerative colitis

Transparency

Declaration of funding

This work was funded by Takeda Development Center Americas Inc., Deerfield, IL, USA.

Author contributions: All authors contributed to study design, data analysis and interpretation. All authors contributed to the drafting of the manuscript and approved the version to be published. All authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

D.T.R. has disclosed that he has received consulting fees from AbbVie Inc., Amgen, Celgene, Emmi, Janssen Pharmaceuticals Inc., Genentech, Pfizer, Prometheus Laboratories, Takeda, and UCB Pharma; he is also a co-founder of Cornerstones Health Inc. and GoDuRn LLC. H.P. has disclosed that she/he is an employee of Immensity Consulting Inc., which has received funding from Takeda Development Center Americas Inc. S.S. has disclosed that she is an employee of Analysis Group, which has received funding from Takeda Development Center Americas Inc. to conduct this study. R.M. has disclosed that she was an employee of Takeda Development Center Americas Inc. and might own stock/stock options; her current affiliation is Research Advisor at Eli Lilly and Company, Indianapolis, Indiana Area.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing assistance was provided by Cinzia Metallo PhD, an employee of Analysis Group.