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P684 A shift to outpatient expenditures in healthcare costs for inflammatory bowel disease: a population-based study in Korea (2010–2014)

C. K. Lee*1, S. Y. Rhee1, H. J. Kim1, S. J. Oh1, C. H. Oh1, W.-M. Lim2

1Kyung Hee University School of Medicine, Internal Medicine, Seoul, South Korea, 2Janssen Korea, Seoul, South Korea

Background

Inflammatory bowel disease (IBD) as a chronic relapsing disorder poses a significant economic burden on the utilisation of healthcare resources. Although recent epidemiologic studies have shown that the incidence and prevalence of IBD in Korea are steadily increasing, data regarding healthcare expenditures for IBD are limited. This population-based study aimed to examine the time trends of IBD-attributable healthcare costs and utilisation and to estimate the nationwide prevalence of IBD in a Korean population from 2010 to 2014.

Methods

We performed a longitudinal analysis on the public dataset derived from the Korean National Health Insurance (NHI) claims data, which covers over 95% of the entire Korean population. We also calculated age-standardised prevalence rates of IBD using the population census data from Statistics Korea.

Results

The nationwide prevalence rate of IBD significantly increased from 0.085% in the general population (0.059% for ulcerative colitis [UC], 0.073% for Crohn’s disease [CD]) in 2010 to 0.105% in the general population (0.069% for UC, 0.036% for CD) in 2014 (p for trend <0.001). There was an approximately 2-fold increase in the overall annual direct healthcare costs for IBD from 27,212,023 thousand won (equivalent to US$ 23 million) in 2010 to 58,465,199 thousand won (equivalent to US$ 50 million) in 2014 (p for trend <0.001). The increase in the overall annual direct healthcare costs was mainly driven by outpatient expenditures; the proportion of outpatient costs increased from 45.5% in 2010 to 66.6% in 2014 (p for trend <0.001). The overall annual number of days that healthcare service was provided to IBD patients increased significantly over the period, but the proportion of hospital in-patient days significantly declined from 26.9% in 2010 to 23.1% in 2014 (all p for trend <0.001). The overall annual number of IBD patients at primary clinics significantly declined over the study period (UC: from 37.8% in 2010 to 27.0% in 2014; CD: from 32.4% in 2010 to 15.6% in 2014), whereas the number of IBD patients at general hospitals or tertiary referral Centres significantly increased during the same period (UC: from 51.6% in 2010 to 62.4% in 2014; CD: from 68.6% in 2010 to 84.3% in 2014) (all p for trend <0.001).

Conclusion

This cost-of-illness study based on nationwide claims data showed an increasing trend for total healthcare costs as well as prevalence of IBD in Korea. The huge increase in total healthcare costs seems to be partly attributable to a shift to outpatient expenditures, suggesting that a cost-effective approach based on specific cost profiles is required for outpatient care.