title: Variations in care: a retrospective database analysis of healthcare utilization patterns for patients with inflammatory bowel disease.
abstract: BACKGROUND
  Biologic therapy has been shown to be effective in achieving and maintaining remission in the treatment of inflammatory bowel disease (IBD). However, their impact on healthcare resource utilization is not well understood. This study explored the impact of biologic use on IBD-related hospital admissions and emergency room visits and healthcare expenditures.
  
  
  METHODS
  This study used a retrospective cohort design to analyze data from the MarketScan Commercial and Medicare databases (Truven Health Analytics Inc.) for the years 2006-2010. Patients were identified using ICD-9 diagnosis codes for IBD and age 18 or older at time of initial diagnosis. Linear models were used to predict the probability of an IBD-related hospitalization or ER visit and healthcare expenditures with binary variables indicating use of biologics in the current year and in the previous 2 years, as well as patient- and area-level control variables.
  
  
  RESULTS
  Patients using biologics in the current year were 14.1-17.6% more likely to be hospitalized for IBD. However, biologic use in the previous year was associated with a 3.8-5.6% reduction in hospitalizations, and biologic use 2 years prior was associated with a 1-2.8% reduction in hospitalizations in the current year. Similar results are found for ER visits. All indicators for biologic use were associated with increased expenditures.
  
  
  CONCLUSIONS
  There was a negative association between lagged use of biologics and the proportion of patients with IBD-related hospitalizations and ER visits. This finding may suggest that increased use of biologics over time is associated with a decrease in IBD-related healthcare utilization.
authors.affiliation: University of Pennsylvania , Philadelphia, PA , USA.
authors.forename: Guy
authors.initials: G
authors.lastname: David
authors.forename: Candace
authors.initials: C
authors.lastname: Gunnarsson
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lofland
mesh_terms: D000328:Adult; D000367:Age Factors; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized
keywords: Healthcare utilization; Inflammatory bowel disease; Quality; Variation in care