P617 Trends in Pediatric Inflammatory Bowel Disease-attributable direct costs: A Canadian population-based analysis
El-Matary, W.(1);Nugent, Z.(2);Witt, J.(3);Bernstein, C.(4);
(1)University of Manitoba, Department of Paediatric Gastroenterology, Winnipeg, Canada;(2)University of Manitoba, IBD Clinical and Research Center- University of Manitoba- Winnipeg- Canada, Winnipeg, Canada;(3)University of Manitoba, Department of Economics, Winnipeg, Canada;(4)University of Manitoba, Department of Internal Medicine, Winnipeg, Canada
Background: In addition to its symptomatic burden, inflammatory bowel disease (IBD) has a major financial burden on patients and healthcare systems. However, there is a paucity of evidence on IBD-attributable costs in children. In a population-based analysis, we determined the trends of IBD-attributable direct costs over 22 years.
Data were extracted from Manitoba Health Provider Claims, and other population registry datasets from 1995 to 2017. Children with IBD were matched by age, sex, and location with children without IBD. IBD-attributable direct costs were calculated using utilization counts from the administrative data and cost estimates from different sources. Inpatient hospitalization and outpatient procedure costs were estimated using the resource intensity weight (RIW) that is attached to each record in the data. Costs were expressed in 2018 Canadian dollars.
We included 733 (428 with Crohn’s disease) prevalent cases who were diagnosed with IBD before the age of 18 years and were followed for 2450 person-years. An age, sex and geography matched control group of 6763 persons without IBD who were followed for 21558 person-years was included. The median annual physician’s billing fees increased from $381 (IQR 215-1064) in 1995 to $936 (IQR 579-1932) in 2017 (p<.001). The annual ambulatory care days for persons with IBD also significantly increased from a median of 8 days per year (IQR 5-13) in 1995 to 12 days per year (IQR 8-17) in 2017 (p < 0.0001) while they remained stable (median 2 days per year) in the control group (p=0.12). The annual medication costs per patient increased from a median of $270.9 in 1995 to $7944 in 2017 (p<.0001). Between 2012 and 2017, the median annual medication costs for all persons on anti-tumor necrosis factor (TNF) medications were $28,582 (IQR 21854-36736)compared to $861for persons with IBD not on an anti-TNF agent (IQR 355-1,714) (p<0.0001) with a relatively stable costs over the 5-year period. The median annual direct costs per patient with IBD was $1810.716 in 2004 as compared to $14791.55 (p<.0001) in 2017.
Over 2 decades, there was a significant increase in the pediatric IBD-attributable direct costs mainly driven by medication costs mainly anti-TNF biologics.