A Nationwide 2010-2012 Analysis of U.S. Health Care Utilization in Inflammatory Bowel Diseases

Inflamm Bowel Dis. 2014 Oct;20(10):1747-53. doi: 10.1097/MIB.0000000000000139.

Abstract

Background: Implementation of the 2010 Affordable Care Act (ACA) calls for a collaborative effort to transform the U.S. health care system toward patient-centered and value-based care. To identify how specialty care can be improved, we mapped current U.S. health care utilization in patients with inflammatory bowel diseases (IBD) using a national insurance claims database.

Methods: We performed a cross-sectional study analyzing U.S. health care utilization in 964,633 patients with IBD between 2010 and 2012 using insurance claims data, including pharmacy and medical claims. Frequency of IBD-related care utilization (medication, tests, and treatments) and their charges were evaluated. Subsequently, outcomes were put into the framework of current U.S. guidelines to identify areas of improvement.

Results: A disproportionate usage of aminosalicylates in Crohn's disease (42%), frequent corticosteroid use (46%, with 9% long-term users), and low rates of corticosteroid-sparing drugs (thiopurines 15%; methotrexate 2.7%) were observed. Markers for inflammatory activity, such as C-reactive protein or fecal calprotectin were not commonly used (8.8% and 0.13%, respectively). Although infrequently used (11%), anti-TNF antibody therapy represents a major part of observed IBD charges.

Conclusions: This analysis shows 2010-2012 utilization and medication patterns of IBD health care in the United States and suggests that improvement can be obtained through enhanced guidelines adherence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Colitis, Ulcerative / prevention & control*
  • Crohn Disease / prevention & control*
  • Cross-Sectional Studies
  • Delivery of Health Care / statistics & numerical data*
  • Follow-Up Studies
  • Health Resources / statistics & numerical data*
  • Humans
  • Medication Adherence
  • National Health Programs
  • Prognosis
  • Retrospective Studies
  • Time Factors