Direct health-care cost utilization in Hong Kong inflammatory bowel disease patients in the initial 2ￂ years following diagnosis

• Published in: Journal of gastroenterology and hepatology Vol. 33; no. 1; p. 141
• Main Authors: Mak, Lung-Yi, Ng, Siew C, Wong, Irene O L, Li, Michael K K, Lo, F H, Wong, Marc T L, Leung, C M, Tsang, Steven W C, Chan, K H, Sze, S F, Shan, Edwin H S, Lam, Belsy C Y, Hui, Aric J, Hung, Ivan F N, Leung, Wai K
• Format: Journal Article
• Language: English
• Published: Richmond Wiley Subscription Services, Inc 01.01.2018
• Subjects: Crohn's disease; Diagnosis; Endoscopy; Hemoglobin; Inflammatory bowel diseases; Intestine; Surgery; Territory; Ulcerative colitis
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.13817

Background and Aim There are scanty data on the health-care utilization from Asia where the incidence of inflammatory bowel disease (IBD) is rising rapidly. We aim to determine the direct health-care costs in the first 2 years of diagnosis in an IBD cohort from Hong Kong and the factors associated with high cost outliers. Methods This is a retrospective cohort study that included patients newly diagnosed with IBD in a territory-wide IBD registry. Patients' clinical information, hospitalization records, investigations, and IBD treatments were retrieved for up to 2 years following diagnosis of IBD. Results Four hundred and thirty-five newly diagnosed IBD patients were included: 198 with Crohn's disease and 237 with ulcerative colitis. Total direct medical expenditure for this cohort 2 years after the IBD diagnosis was $7 072 710: hospitalizations (33%), 5-aminosalicylic acid (23%), imaging and endoscopy (17%), outpatient visits (10%), surgery (8%), and biologics (6%). Mean direct medical costs per patient-year were significantly higher for Crohn's disease ($9918) than ulcerative colitis ($6634; P, 0.001). The total direct health-care cost decreased significantly after transition to the second year (P < 0.01). High cost (> 90th percentile) outliers were associated with surgery (OR 7.1, 95% CI 2.9-17.2) and low hemoglobin on presentation (OR 0.83, 95% CI 0.70-0.96). Conclusions Hospitalization and 5-aminosalicylic acid usage accounted for 56% of total direct medical costs in the first 2 years of our newly diagnosed IBD patients. Direct health-care costs were higher in the first year compared with the second year of diagnosis. Surgery and low hemoglobin on presentation were associated with high cost outliers.