Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results from a Canadian Population-Based Analysis

Laura E. Targownik; Gilaad G. Kaplan; Julia Witt; Charles N. Bernstein; Harminder Singh; Aruni Tennakoon; Antonio Aviña Zubieta; Stephanie B. Coward; Jennifer Jones; M. Ellen Kuenzig; Sanjay K. Murthy; Geoffrey C. Nguyen; Juan Nicolás Peña-Sánchez; Eric I. Benchimol

doi:10.14309/ajg.0000000000000503

Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results from a Canadian Population-Based Analysis

Laura E. Targownik, Gilaad G. Kaplan, Julia Witt, Charles N. Bernstein, Harminder Singh, Aruni Tennakoon, Antonio Aviña Zubieta, Stephanie B. Coward, Jennifer Jones, M. Ellen Kuenzig, Sanjay K. Murthy, Geoffrey C. Nguyen, Juan Nicolás Peña-Sánchez, Eric I. Benchimol

Medicine

Research output: Contribution to journal › Review article › peer-review

46 Citations (Scopus)

Abstract

OBJECTIVES:The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy.DESIGN:We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU.RESULTS:The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63).DISCUSSION:The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.

Original language	English
Pages (from-to)	128-137
Number of pages	10
Journal	American Journal of Gastroenterology
Volume	115
Issue number	1
DOIs	https://doi.org/10.14309/ajg.0000000000000503
Publication status	Published - Jan 1 2020

Bibliographical note

Funding Information:
This study was funded through a Grants-in-Aid of Research Grant from Crohn’s and Colitis Canada and the Helmsley Foundation. We thank the Canadian Gastro-Intestinal Epidemiologic Consortium (CanGIEC) for their support. We thank Adebanke Oketola for her organization and coordination of study data.

Funding Information:
Guarantor of the article: Laura E. Targownik, MD, MSHS. Specific author contributions: Study concept and design: L.E.T., E.I.B., G.G.K., C.N.B., J.W., and H.S. Acquisition of data: L.E.T., C.N.B., and A.T. Analysis and interpretation of data: L.E.T., E.I.B., G.G.K., C.N.B., J.W., H.S., S.B.C., and M.E.K. Drafting of the manuscript: L.E.T. Critical revision of the manuscript for important intellectual content: L.E.T., G.G.K., J.W., C.N.B., H.S., A.T., A.A.Z., S.B.C., J.J., M.E.K., A.K.K., G.C.N., J.N.P.-S., and E.I.B. Statistical analysis: L.E.T. and A.T. Obtained funding: L.E.T. Financial support: L.E.T. has received investigator initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Takeda Canada, Merck Canada, Pfizer Canada, and Mallinckrodt, USA. C.N.B. has served on advisory Boards for AbbVie Canada, Ferring Canada, Janssen Canada, Shire Canada, Takeda Canada, and Pfizer Canada; consultant for Mylan Pharmaceuticals; and educational grants from Abbvie Canada, Shire Canada, Takeda Canada, and Janssen Canada. Speaker’s panel for Abbvie Canada, Ferring Canada, Medtronic Canada, and Shire Canada. Received research funding from Abbvie Canada. H.S. has been on advisory board of Pendopharm, Ferring, Takeda, and Merck Canada; received educational grant from Ferring and investigator initiated research funding from Merck Canada. J.J. has been on advisory boards, acted as a consultant, and been a speaker for Advisory, consultant, and speaker fees for Janssen, Abbvie. G.G.K. has received speaking or consultancy honoraria from AbbVie, Janssen, Pfizer, Takeda, and Shire. He has received a grant from Abbvie, Janssen, Merck, and Shire. S.K.M. has received honoraria for speaking or consultancy from Abbvie, Janssen, Takeda, Pfizer, Shire, and Ferring. E.I.B. was supported by a New Investigator Award from the Canadian Institutes of Health Research, Crohn’s and Colitis Canada, and Canadian Association of Gastroenterology. E.I.B. was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. M.E.K. was supported by a Post-Doctoral Fellowship Award from the Canadian Institutes of Health Research (CIHR), Canadian Association of Gastroenterology (CAG), and Crohn’s and Colitis Canada. Potential competing interests: None to report. This study is based in part on deidentified data Manitoba Health, obtained with the permission of the Manitoba Health Information Privacy Committee. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Manitoba.

Publisher Copyright:
© 2019 by The American College of Gastroenterology.

ASJC Scopus Subject Areas

Hepatology
Gastroenterology

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't

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10.14309/ajg.0000000000000503

Cite this

Targownik, L. E., Kaplan, G. G., Witt, J., Bernstein, C. N., Singh, H., Tennakoon, A., Aviña Zubieta, A., Coward, S. B., Jones, J., Kuenzig, M. E., Murthy, S. K., Nguyen, G. C., Peña-Sánchez, J. N., & Benchimol, E. I. (2020). Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results from a Canadian Population-Based Analysis. American Journal of Gastroenterology, 115(1), 128-137. https://doi.org/10.14309/ajg.0000000000000503

Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results from a Canadian Population-Based Analysis. / Targownik, Laura E.; Kaplan, Gilaad G.; Witt, Julia et al.
In: American Journal of Gastroenterology, Vol. 115, No. 1, 01.01.2020, p. 128-137.

Research output: Contribution to journal › Review article › peer-review

Targownik, LE, Kaplan, GG, Witt, J, Bernstein, CN, Singh, H, Tennakoon, A, Aviña Zubieta, A, Coward, SB, Jones, J, Kuenzig, ME, Murthy, SK, Nguyen, GC, Peña-Sánchez, JN & Benchimol, EI 2020, 'Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results from a Canadian Population-Based Analysis', American Journal of Gastroenterology, vol. 115, no. 1, pp. 128-137. https://doi.org/10.14309/ajg.0000000000000503

@article{b9c8e640161f4362902404b0deb05e8d,

title = "Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results from a Canadian Population-Based Analysis",

abstract = "OBJECTIVES:The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy.DESIGN:We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU.RESULTS:The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63).DISCUSSION:The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.",

author = "Targownik, {Laura E.} and Kaplan, {Gilaad G.} and Julia Witt and Bernstein, {Charles N.} and Harminder Singh and Aruni Tennakoon and {Avi{\~n}a Zubieta}, Antonio and Coward, {Stephanie B.} and Jennifer Jones and Kuenzig, {M. Ellen} and Murthy, {Sanjay K.} and Nguyen, {Geoffrey C.} and Pe{\~n}a-S{\'a}nchez, {Juan Nicol{\'a}s} and Benchimol, {Eric I.}",

note = "Funding Information: This study was funded through a Grants-in-Aid of Research Grant from Crohn{\textquoteright}s and Colitis Canada and the Helmsley Foundation. We thank the Canadian Gastro-Intestinal Epidemiologic Consortium (CanGIEC) for their support. We thank Adebanke Oketola for her organization and coordination of study data. Funding Information: Guarantor of the article: Laura E. Targownik, MD, MSHS. Specific author contributions: Study concept and design: L.E.T., E.I.B., G.G.K., C.N.B., J.W., and H.S. Acquisition of data: L.E.T., C.N.B., and A.T. Analysis and interpretation of data: L.E.T., E.I.B., G.G.K., C.N.B., J.W., H.S., S.B.C., and M.E.K. Drafting of the manuscript: L.E.T. Critical revision of the manuscript for important intellectual content: L.E.T., G.G.K., J.W., C.N.B., H.S., A.T., A.A.Z., S.B.C., J.J., M.E.K., A.K.K., G.C.N., J.N.P.-S., and E.I.B. Statistical analysis: L.E.T. and A.T. Obtained funding: L.E.T. Financial support: L.E.T. has received investigator initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Takeda Canada, Merck Canada, Pfizer Canada, and Mallinckrodt, USA. C.N.B. has served on advisory Boards for AbbVie Canada, Ferring Canada, Janssen Canada, Shire Canada, Takeda Canada, and Pfizer Canada; consultant for Mylan Pharmaceuticals; and educational grants from Abbvie Canada, Shire Canada, Takeda Canada, and Janssen Canada. Speaker{\textquoteright}s panel for Abbvie Canada, Ferring Canada, Medtronic Canada, and Shire Canada. Received research funding from Abbvie Canada. H.S. has been on advisory board of Pendopharm, Ferring, Takeda, and Merck Canada; received educational grant from Ferring and investigator initiated research funding from Merck Canada. J.J. has been on advisory boards, acted as a consultant, and been a speaker for Advisory, consultant, and speaker fees for Janssen, Abbvie. G.G.K. has received speaking or consultancy honoraria from AbbVie, Janssen, Pfizer, Takeda, and Shire. He has received a grant from Abbvie, Janssen, Merck, and Shire. S.K.M. has received honoraria for speaking or consultancy from Abbvie, Janssen, Takeda, Pfizer, Shire, and Ferring. E.I.B. was supported by a New Investigator Award from the Canadian Institutes of Health Research, Crohn{\textquoteright}s and Colitis Canada, and Canadian Association of Gastroenterology. E.I.B. was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. M.E.K. was supported by a Post-Doctoral Fellowship Award from the Canadian Institutes of Health Research (CIHR), Canadian Association of Gastroenterology (CAG), and Crohn{\textquoteright}s and Colitis Canada. Potential competing interests: None to report. This study is based in part on deidentified data Manitoba Health, obtained with the permission of the Manitoba Health Information Privacy Committee. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Manitoba. Publisher Copyright: {\textcopyright} 2019 by The American College of Gastroenterology.",

year = "2020",

month = jan,

day = "1",

doi = "10.14309/ajg.0000000000000503",

language = "English",

volume = "115",

pages = "128--137",

journal = "American Journal of Gastroenterology",

issn = "0002-9270",

publisher = "Nature Publishing Group",

number = "1",

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TY - JOUR

T1 - Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era

T2 - Results from a Canadian Population-Based Analysis

AU - Targownik, Laura E.

AU - Kaplan, Gilaad G.

AU - Witt, Julia

AU - Bernstein, Charles N.

AU - Singh, Harminder

AU - Tennakoon, Aruni

AU - Aviña Zubieta, Antonio

AU - Coward, Stephanie B.

AU - Jones, Jennifer

AU - Kuenzig, M. Ellen

AU - Murthy, Sanjay K.

AU - Nguyen, Geoffrey C.

AU - Peña-Sánchez, Juan Nicolás

AU - Benchimol, Eric I.

N1 - Funding Information: This study was funded through a Grants-in-Aid of Research Grant from Crohn’s and Colitis Canada and the Helmsley Foundation. We thank the Canadian Gastro-Intestinal Epidemiologic Consortium (CanGIEC) for their support. We thank Adebanke Oketola for her organization and coordination of study data. Funding Information: Guarantor of the article: Laura E. Targownik, MD, MSHS. Specific author contributions: Study concept and design: L.E.T., E.I.B., G.G.K., C.N.B., J.W., and H.S. Acquisition of data: L.E.T., C.N.B., and A.T. Analysis and interpretation of data: L.E.T., E.I.B., G.G.K., C.N.B., J.W., H.S., S.B.C., and M.E.K. Drafting of the manuscript: L.E.T. Critical revision of the manuscript for important intellectual content: L.E.T., G.G.K., J.W., C.N.B., H.S., A.T., A.A.Z., S.B.C., J.J., M.E.K., A.K.K., G.C.N., J.N.P.-S., and E.I.B. Statistical analysis: L.E.T. and A.T. Obtained funding: L.E.T. Financial support: L.E.T. has received investigator initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Takeda Canada, Merck Canada, Pfizer Canada, and Mallinckrodt, USA. C.N.B. has served on advisory Boards for AbbVie Canada, Ferring Canada, Janssen Canada, Shire Canada, Takeda Canada, and Pfizer Canada; consultant for Mylan Pharmaceuticals; and educational grants from Abbvie Canada, Shire Canada, Takeda Canada, and Janssen Canada. Speaker’s panel for Abbvie Canada, Ferring Canada, Medtronic Canada, and Shire Canada. Received research funding from Abbvie Canada. H.S. has been on advisory board of Pendopharm, Ferring, Takeda, and Merck Canada; received educational grant from Ferring and investigator initiated research funding from Merck Canada. J.J. has been on advisory boards, acted as a consultant, and been a speaker for Advisory, consultant, and speaker fees for Janssen, Abbvie. G.G.K. has received speaking or consultancy honoraria from AbbVie, Janssen, Pfizer, Takeda, and Shire. He has received a grant from Abbvie, Janssen, Merck, and Shire. S.K.M. has received honoraria for speaking or consultancy from Abbvie, Janssen, Takeda, Pfizer, Shire, and Ferring. E.I.B. was supported by a New Investigator Award from the Canadian Institutes of Health Research, Crohn’s and Colitis Canada, and Canadian Association of Gastroenterology. E.I.B. was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. M.E.K. was supported by a Post-Doctoral Fellowship Award from the Canadian Institutes of Health Research (CIHR), Canadian Association of Gastroenterology (CAG), and Crohn’s and Colitis Canada. Potential competing interests: None to report. This study is based in part on deidentified data Manitoba Health, obtained with the permission of the Manitoba Health Information Privacy Committee. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Manitoba. Publisher Copyright: © 2019 by The American College of Gastroenterology.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - OBJECTIVES:The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy.DESIGN:We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU.RESULTS:The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63).DISCUSSION:The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.

AB - OBJECTIVES:The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy.DESIGN:We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU.RESULTS:The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63).DISCUSSION:The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.

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Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results from a Canadian Population-Based Analysis

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