A Detailed Analysis of Cost-Drivers in Healthcare Expenditures in IBD

Findings presented at the 2024 Crohns’ and Colitis Congress show the significant burden of unmanaged IBD symptoms driving significant ER and high-cost medication utilization

Care for inflammatory bowel diseases (IBD) carries a significant financial burden on the US healthcare system and these costs are rapidly increasing. There is a critical need to better understand the determinants of IBD costs in a real-world population in order to develop strategies to impact this rising cost curve.

Significant medical utilization in IBD

Oshi Health conducted a real-world descriptive cohort study using data from IBM Watson, a nationwide insurance claims database covering millions of commercially insured individuals across the US. 

We identified 105,496 adult patients aged 18 to 65 years with encounters associated with a diagnosis of IBD in the primary or secondary position from January 2019 to January 2020 based on ICD-10-CM codes for Crohn’s disease (555.x) and ulcerative colitis (556.x). 

Analysis of IBD prevalence, costs, and service utilization was based on ICD, CPT, and NDC codes related to IBD conditions and services. All other codes without an associated GI diagnosis in the primary or secondary position were attributed to all-cause costs. Measures of cost and utilization were calculated as a per member per year (PMPY). 

Analysis of GI and all-cause costs

Mean PMPY total costs were $40,842 of which $31,051 (76%) were directly related to GI-related costs. Mean PMPY total costs in this population ranged from $1,178 to $144,945, with 15% of members experiencing costs > $76,346 PMPY. 

The main drivers of GI-related costs can be divided into the following three categories: 

• Inpatient costs ($8,206 [26%])
• Outpatient medical service costs ($11,306 [36%])
• Drug costs ($11,539 [37%]) 

Noteworthy: $5,055 of the $11,306 attributed to outpatient costs were related to GI-related medication administration facility services. 

Per member utilization includes: 

Mean cost breakdown and service utilization per member:

The path to improve quality and reduce cost of care

Unplanned emergency service and medication utilization continue to make up the majority of costs of IBD care and need to be the focus of value-based interventions aimed at controlling costs while maintaining quality. 

While appropriate high-cost pharmaceutical utilization should not be reduced, innovative strategies leveraging more cost-effective medication delivery (home-based infusions and subcutaneous injections) as well as the incorporation of biosimilar/generic medication may provide an important opportunity for curbing costs.  

Furthermore, the high rate of non-gastroenterologist GI visits suggests that there is a potential for optimizing care pathways by incorporating multidisciplinary care including primary medical doctors, mid-level providers, and other ancillary services (such as dieticians and mental health professionals) into the IBD care model. 

Effective management of IBD should focus on improving patient symptoms and outcomes while containing healthcare costs.  High-value treatment strategies and policy changes to enable high-value care starts with a better understanding of primary cost drivers in populations such as those with IBD. Using this data to inform the application of value-based interventions,  we can drive much-needed changes to transform available care options.