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P532. Economic burden of common comorbidities associated with ulcerative colitis

R.D. Cohen1, J. Rizzo2, A. Soliman3, M. Yang2, M. Skup2, P.M. Mulani2, J. Chao2, 1University of Chicago, Chicago, IL, United States, 2Abbott Laboratories, Abbott Park, IL, United States, 3University of Minnesota, Minneapolis, MN, United States

Background

We compared medical utilisation and associated direct costs of privately insured US employees with ulcerative colitis (UC) and common comorbid conditions to employees with UC alone.

Methods

Employed patients (pts) 18–65 years old with ≥2 UC diagnoses (ICD-9: 556.xx) were selected from Truven Health MarketScan® Commercial Claims and Encounters Databases (1/1/2000–12/31/2010). Comorbidities identified during the 1-year baseline period prior to a randomly chosen UC diagnosis date (index date) included: autoimmune disease, pulmonary disease, diabetes, hypertension, malignancy, psychiatric disorders, and heart disease. Medical resource utilisation (overnight hospitalisations, emergency department [ED] visits, hospital day visits, and physician outpatient [OP] visits) and associated costs during the 1-year period following the index date were compared for pts with ≥1 comorbidity vs. those without. A multivariate analysis compared direct costs adjusting for age, sex, and Charlson score. Analyses were also performed for a subgroup of pts with moderate to severe UC (UC hospitalisation or use of systemic corticosteroids, immunosuppressants, or biologics).

Results

10,264 UC pts with ≥1 common comorbidity at baseline and 12,604 UC pts with no common comorbidity at baseline were included. Medical resource utilisation was significantly greater in the group with comorbidities vs without (0.33 vs 0.18 ED visits; 0.34 vs 0.16 overnight hospitalisations; 4.32 vs 2.22 hospital day visits; 14.63 vs 8.31 OP visits). Direct costs were also significantly higher for the comorbidity group (Table). In the moderate to severe pts, employees with comorbidities (N = 1849) vs those without (N = 1956) had significantly higher medical resource usage (0.46 vs 0.22 ED visits; 0.48 vs 0.27 overnight hospitalisations; 5.11 vs 2.81 hospital day visits; 16.62 vs 9.37 OP visits) and greater direct costs (Table).

Table: Annual health care costs (2010 US$) of comorbidities in UC patients
 Average annual direct healthcare costs
 All employees with UCEmployees with moderate/severe UC
 With co-morbidityNo co-morbidityP-ValueWith co-morbidityNo co-morbidityP-value
ED visits$301$160<0.0001b$390$196<0.0001b
Overnight hospitalisations$5,644$2,239<0.0001b$7,955$4,110<0.0001b
Other servicesa$1,243$375<0.0001b$1,770$597<0.0001b
Hospital day visits$4,448$2,183<0.0001b$5,043$2,726<0.0001b
OP visits$2,969$1,464<0.0001b$3,393$2,013<0.0001b
Prescription drug$4,788$2,549<0.0001b$6,123$3,434<0.0001b
Adjusted total direct$23,386$13,242<0.0001c$27,775$17,061<0.0001c
aAmbulance and durable medical equipment services. bWilcoxon rank sum test. cGeneralised linear regression model.

Conclusion

Employed UC pts with comorbidities had greater use of medical resources and higher medical costs, especially in moderate to severe UC. Treatment strategies for pts with UC should take into account comorbidities.