High end of life health care costs and hospitalization burden in inflammatory bowel disease patients: A population-based study

<div><p>Background</p><p>End of life (EOL) care is associated with greater costs, particularly for acute care services. In patients with inflammatory bowel disease (IBD), EOL costs may be accentuated due to reliance on hospital-based services and expensive diagnostic tests and treatments. We aimed to compare EOL health care use and costs between IBD and non-IBD decedents.</p><p>Methods</p><p>We conducted a retrospective cohort study of all decedents of Ontario, Canada between 2010 and 2013 using linked health administrative data. IBD (N = 2,214) and non-IBD (N = 262,540) decedents were compared on total direct health care costs in the last year of life and hospitalization time during the last 90 days of life.</p><p>Results</p><p>During the last 90 days of life, IBD patients spent an average of 16 days in hospital, equal to 2.1 greater adjusted hospital days (95% confidence interval [CI] 1.5–2.8 days) than non-IBD patients. IBD diagnosis was associated with $7,210 CAD (95$5,005 - $9,464) higher adjusted per-patient cost in the last year of life, of which 76% was due to excess hospitalization costs. EOL cost of IBD care was higher than 15 of 16 studied chronic conditions. Health care costs rose sharply in the last 90 days of life, primarily due to escalating hospitalization costs.</p><p>Conclusions</p><p>IBD patients spend more time in hospital and incur substantially greater health care costs than other decedents as they approach the EOL. These excess costs could be curtailed through avoidance of unnecessary hospitalizations and expensive treatments in the setting of irreversible deterioration.</p></div

Multiple linear regression model of number of hospital days per person in the last 90 days of life.

<p>Multiple linear regression model of number of hospital days per person in the last 90 days of life.</p

Multiple linear regression model of health care costs per person in the last year of life.^a

<p>Multiple linear regression model of health care costs per person in the last year of life.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177211#t003fn001" target="_blank">^a</a></p

Baseline characteristics of study patients.

<p>Baseline characteristics of study patients.</p

Mean health care sector costs per patient and frequency of health care sector usage in the last year of life among IBD and non-IBD decedents.

<p>Mean health care sector costs per patient and frequency of health care sector usage in the last year of life among IBD and non-IBD decedents.</p

Mean individual direct health care costs per month over the last year of life.

<p>Top Panel: Total costs in IBD and non-IBD patients. Middle Panel: Total and sector-specific costs in IBD patients. Bottom Panel: Total and sector-specific costs in non-IBD patients.</p

Mean direct health care costs per patient in the last year of life across various chronic diseases.

<p>Mean direct health care costs per patient in the last year of life across various chronic diseases.</p

Past and future burden of inflammatory bowel diseases based on modeling of population-based data

BACKGROUND & AIMS: Inflammatory bowel diseases (IBDs) exist worldwide, with high prevalence in North America. IBD is complex and costly, and its increasing prevalence places a greater stress on health care systems. We aimed to determine the past current, and future prevalences of IBD in Canada. METHODS: We performed a retrospective cohort study using population-based health administrative data from Alberta (2002–2015), British Columbia (1997– 2014), Manitoba (1990–2013), Nova Scotia (1996–2009), Ontario (1999–2014), Quebec (2001–2008), and Saskatchewan (1998–2016). Autoregressive integrated moving average regression was applied, and prevalence, with 95% prediction intervals (PIs), was forecasted to 2030. Average annual percentage change, with 95% confidence intervals, was assessed with log binomial regression. RESULTS: In 2018, the prevalence of IBD in Canada was estimated at 725 per 100,000 (95% PI 716–735) and annual average percent change was estimated at 2.86% (95% confidence interval 2.80%–2.92%). The prevalence in 2030 was forecasted to be 981 per 100,000 (95% PI 963–999): 159 per 100,000 (95% PI 133–185) in children, 1118 per 100,000 (95% PI 1069–1168) in adults, and 1370 per 100,000 (95% PI 1312–1429) in the elderly. In 2018, 267,983 Canadians (95% PI 264,579–271,387) were estimated to be living with IBD, which was forecasted to increase to 402,853 (95% PI 395,466–410,240) by 2030. CONCLUSION: Forecasting prevalence will allow health policy makers to develop policy that is necessary to address the challenges faced by health systems in providing high-quality and cost-effective care