An evaluation of health care expenditures in Crohn's disease using the United States Medical Expenditure Panel Survey from 2003 to 2013.
Previous estimates of the economic burden of Crohn's disease (CD) varied widely from $2.0 to $18.2 billion per year (adjusted to 2015 $US). However, these estimates do not reflect recent changes in pharmaceutical treatment options and guidelines.



The goal of this study was to update cost estimates of Crohn's disease based on a representative sample of the US population from the most recent 11 years (2003-2013) of the Medical Expenditure Panel Survey (MEPS). A secondary aim described expenditure trends in respondents with and without Crohn's disease pre-post FDA approvals of new biologics and the American College of Gastroenterology Crohn's disease treatment guidelines.



Average annual expenditures (total, prescription, inpatient, and outpatient) were evaluated using a pooled cross-sectional design. Respondent data from the most recent 11 years (2003-2013) of MEPS were analyzed. Two-part generalized linear models with power-link were used to estimate the average annual expenditures per patient adjusted to multiple covariates. Confidence intervals (CI) were estimated using bootstrap methods. Difference-in-differences estimations were performed to compare the changes in health care expenditures pre-post FDA approvals of new biologics and the American College of Gastroenterology Crohn's disease treatment guidelines.



The annual aggregate economic burden of CD was $6.3 billion in the US. Respondents with CD had higher total (+$6442; 95% CI: $4864 to $8297), prescription (+$3283; 95% CI: $2289 to $4445), inpatient (+$1764; 95% CI: $748 to $3551), and outpatient (+$1191; 95% CI: $592 to $2160) expenditures compared to respondents without CD. In the difference-in-differences estimation, respondents with CD had significantly higher total (P = 0.001) and prescription (P < 0.001) expenditures compared with respondents without CD. Although inpatient and outpatient expenditures were higher in respondents with CD, they were not statistically significant.



Respondents with CD diagnosis had higher expenditures compared to respondents without CD diagnosis from 2003 to 2013. This study captured the most recent availability of new treatment options and changes to treatment guidelines, while providing updated estimates of the economic burden of CD in the US. However, this research was unable to study the causes of these increased health care expenditures in respondents with CD. Future investigations will need to determine the causal factors for increased expenditures in CD.
Pharmaceutical Outcomes Research and Policy Program, University of Washington, USA. Electronic address: mbounth@uw.edu.
Mark
M
Bounthavong
Pharmaceutical Outcomes Research and Policy Program, University of Washington, USA.
Meng
M
Li
Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, USA.
Jonathan H
JH
Watanabe
D000328:Adult; D001688:Biological Products / Q000627:therapeutic use; D017281:Cost of Illness; D003424:Crohn Disease / Q000191:economics* / Q000628:therapy; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics*; D017277:Drug Approval; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014481:United States; D014486:United States Food and Drug Administration
D001688:Biological Products
Biologics; Costs; Crohn's disease; Economics; Expenditures; Health care; Inpatient; Medical Expenditure Panel Survey; Outpatient; Prescription; Treatment