title: Health Insurance Paid Costs and Drivers of Costs for Patients With Crohn's Disease in the United States.
abstract: OBJECTIVE
  The cost of medical care for Crohn's disease (CD) and comorbidities in the era of biologics is unclear. We examined insurance claims data from US health plans to understand this relationship.
  
  
  METHODS
  Longitudinal CD patient data and reimbursement information from 11 health plans engaged with Accordant Health Services between 2011 and 2013 were analyzed. The analysis considered data for all CD patients and for the patient subgroup ≤20 years and >20 years of age. Descriptive statistics measured the mean health-plan paid costs per patient, the relative cost contribution of anti-tumor necrosis factor (TNF) agents, and health care costs for 31 specific comorbid conditions among CD patients.
  
  
  RESULTS
  Overall, there were 5,090 CD patients (57% women) of which 587 CD patients were ≤20 years of age. The mean health-plan paid cost per member per year was $18,637 (s.d. $32,023) for all CD patients, $22,796 (s.d. $ 41,905) for CD patients ≤20 years, and $18,095 (s.d. $30,065) for patients >20 years of age. Twenty-eight percent of CD patients accounted for 80% of total costs. No differences were found in costs based on gender. Increased health-plan paid costs were significantly correlated with the number of comorbid conditions across all ages. Pharmacy utilization costs account for nearly one-half (45.5%) of the total CD-attributable costs, exceeding inpatient care costs. Anti-TNF agents alone comprised nearly one-third (29.5%) of total costs. Aside from anti-TNF costs, other major categories of expense were as follows: inpatient 23.1%, outpatient hospital setting 15.7%, and MD office 8.2%.
  
  
  CONCLUSIONS
  Total health-care costs in CD exceed previous estimates, with the majority of costs being allocated to a relatively small subgroup of patients. Pharmacy utilization costs, owing to anti-TNF use, result in increasing total health-care costs and currently exceed costs for inpatient care. Pragmatic strategies to encourage gastroenterologists in the best clinical practice of optimizing anti-TNF use-in particular for younger age patients and those with multiple comorbidities-are necessary to reduce avoidable pharmacy utilization and inpatient care costs.
authors.affiliation: Division of Gastroenterology, Department of Pediatrics, Stanford University, Palo Alto, California, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Pediatrics, University of Vermont, Burlington, Vermont, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Colletti
authors.affiliation: Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Rubin
authors.affiliation: Accordant Health Services, a CVS Caremark Company, Greensboro, North Carolina, USA.
authors.forename: Bal K
authors.initials: BK
authors.lastname: Sharma
authors.affiliation: Accordant Health Services, a CVS Caremark Company, Greensboro, North Carolina, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Accordant Health Services, a CVS Caremark Company, Greensboro, North Carolina, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Krueger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha