P851 Impact of an integrated model of care for inflammatory bowel disease on direct healthcare costs: A population-based matched cohort study from Saskatchewan, Canada
Maldonado, F.(1,2)*;Penz, E.(3);Jones, J.(4);Pena-Sanchez, J.N.(2);
(1)Health Quality Council of Saskatchewan, Data and Analytics, Saskatoon, Canada;(2)University of Saskatchewan, Community Health and Epidemiology- College of Medicine, Saskatoon, Canada;(3)University of Saskatchewan, Division of Respirology- Critical Care and Sleep Medicine- Department of Medicine- College of Medicine, Saskatoon, Canada;(4)Dalhousie University, Department of Medicine and Department of Community Health and Epidemiology- College of Medicine, Halifax, Canada;
Background
Integrated models of care (IMC) for IBD lead to reduced hospitalizations, surgeries, comorbidities, and overall improved outcomes. There are limited studies assessing the impact of IMC on direct healthcare costs. We aimed to estimate the impact of exposure to an IMC on direct healthcare costs among individuals diagnosed with IBD.
Methods
We conducted a quasi-experimental difference-in-difference (DID) cost analysis using administrative health data from Saskatchewan, Canada. We included individuals ≥18 years old meeting a validated administrative IBD case definition between January 2009 and March 2015. IBD cases were classified as exposed or non-exposed to the Saskatchewan IMC and required to have three years of healthcare coverage after baseline (i.e., first visit with an IMC [exposed] or a non-IMC [non-exposed] gastroenterologist). The direct healthcare costs were derived from the administrative databases, adjusted to 2014/15 Canadian dollars, and categorized into hospitalizations, physician visits, and medication claim costs (i.e., immunomodulators [IMM], biologics [BIOL], aminosalicylates[5-ASA]). Propensity scores (PS) were calculated based on healthcare utilization and comorbidities in the 12 months before baseline. Cases (exposed) were matched 1:5 controls (non-exposed) based on PS and disease duration. DID estimators were determined for each cost category using mixed linear regression models including age, sex, disease type, and area of residence as covariables.
Results
In total, 2905 IBD cases were included in the study, 597 exposed and 2308 non-exposed individuals (Figure); the majority were females (52%), lived in urban areas (74%), and had Crohn’s Disease (61%). The mean age was 44.6 years (SD=15.5) and the average disease duration at baseline was 5.7 years (SD=5). In comparison to the non-exposed group, the costs of physician visits (IBD-related [DID= $-139, 95%CI -209 to -68], IBD-specific [DID=$-155, 95%CI -212 to -97], and specialty visits [DID=$-135, 95%CI -201 to -69]); and IMM dispensations (DID=$-18, 95%CI -35 to -2) were lower in the exposed group. Conversely, we identified higher total healthcare costs (DID=$1707, 95%CI 369 to 3044); IBD-related medication (DID=$2341, 95%CI 1484 to 3197) and BIOL (DID= $2467, 95%CI 1605 to 3328) dispensations costs in the exposed group. There were no other statistically significant differences between the groups.
Conclusion
We identified lower physician visit and IMM costs in the exposed group than in the non-exposed one. Total healthcare costs were higher among the exposed group, largely driven by higher BIOL costs. These results highlight the potential cost impact of IMC for IBD and the need for cost-effectiveness studies of IMC to further assess value of this care model.