Group-Based Trajectory Modeling of Healthcare Financial Charges in Inflammatory Bowel Disease: A Comprehensive Phenotype

Overview

Journal Clin Transl Gastroenterol

Specialty Gastroenterology

Date 2016 Jul 15

PMID 27415619

Citations 7

Authors

Jianfei Jiang

Benjamin Click

Alyce M Anderson

Ioannis E Koutroubakis

Claudia Ramos Rivers

Jana G Hashash

Michael A Dunn

Marc Schwartz

Jason Swoger

Arthur Barrie

Miguel Regueiro

Chung-Chou H Chang

David G Binion

Affiliations

Soon will be listed here.

Abstract

Objectives: Inflammatory bowel disease (IBD) is a heterogeneous group of chronic inflammatory gastrointestinal conditions with variable disease courses often requiring significant healthcare expenditures. We aimed to identify disease trajectory patterns based on longitudinal financial expenditures and to assess the association of classic disease activity parameters with financial charges.

Methods: This was an analysis of a consented, prospective, natural history IBD registry (2009-2013) from a tertiary IBD center of 2,203 patients and their associated medical charges excluding pharmacy expenses. We applied group-based trajectory modeling to longitudinal healthcare financial charges to determine patterns of charges. We assessed the association between charge patterns and disease activity, quality of life, healthcare utilization, and medication requirement.

Results: The final model included 1,600 IBD patients with 5-year charges. We identified six distinct trajectories over the study period. Consistently High charges were associated with Crohn's disease (66.0% Consistently High patients, P<0.01), perianal involvement (22.6%, P<0.01), ulcerative colitis extent (89.7% extensive, P=0.01), prior IBD surgery (52.5%, P<0.01), and depression/anxiety (36.2%, P<0.01). Compared with other trajectories, Consistently High charges had higher 5-year disease activity indices (Harvey-Bradshaw P<0.01; ulcerative colitis activity index P<0.01), elevated C-reactive protein rates (72.3%, P<0.01), IBD surgery (64.5%, P<0.01), hospitalization (97.2%, P<0.01), corticosteroid (70.9%, P<0.01) and antitumor necrosis factor requirement (50.4%, P<0.01), and worse quality of life (P<0.01). Annual trends in parameters were reflected in temporal changes in financial charges. The majority of financial burden stemmed from inpatient care.

Conclusions: Healthcare financial charges represent a novel phenotype in IBD that reflect trends in classic disease activity parameters and allow for subgroup identification of temporal disease trajectories.

Citing Articles

Empirical sample-specific approaches to define HPV16 and HPV18 seropositivity in unvaccinated, young, sexually active women.

Ng K, Morais S, Wissing M, Burchell A, Tellier P, Coutlee F Microbiol Spectr. 2024; 12(6):e0022924.

PMID: 38687066 PMC: 11324019. DOI: 10.1128/spectrum.00229-24.

Trajectory analysis of rhinitis in a birth cohort from lower-income New York City neighborhoods.

Flores N, Lovinsky-Desir S, Divjan A, Hoepner L, Zou J, Miller R J Allergy Clin Immunol. 2023; 154(1):111-119.

PMID: 38104949 PMC: 11180217. DOI: 10.1016/j.jaci.2023.11.919.

Predictors of High Health Care Utilization in Patients With Inflammatory Bowel Disease Within 1 Year of Establishing Specialist Care.

Chudy-Onwugaje K, Mamunes A, Schwartz D, Horst S, Cross R Inflamm Bowel Dis. 2020; 27(3):325-335.

PMID: 32488231 PMC: 7885330. DOI: 10.1093/ibd/izaa070.

Variability of cost trajectories over the last year of life in patients with advanced breast cancer in the Netherlands.

Schneider P, Pouwels X, Passos V, Ramaekers B, Geurts S, Ibragimova K PLoS One. 2020; 15(4):e0230909.

PMID: 32271794 PMC: 7145011. DOI: 10.1371/journal.pone.0230909.

The Association Between Sustained Poor Quality of Life and Future Opioid Use in Inflammatory Bowel Disease.

Anderson A, Click B, Ramos-Rivers C, Koutroubakis I, Hashash J, Dunn M Inflamm Bowel Dis. 2018; 24(7):1380-1388.

PMID: 29860492 PMC: 6085986. DOI: 10.1093/ibd/izy040.

References

Silverberg M, Satsangi J, Ahmad T, Arnott I, Bernstein C, Brant S . Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005; 19 Suppl A:5A-36A. DOI: 10.1155/2005/269076. View

Kozarek R, Patterson D, GELFAND M, Botoman V, Ball T, WILSKE K . Methotrexate induces clinical and histologic remission in patients with refractory inflammatory bowel disease. Ann Intern Med. 1989; 110(5):353-6. DOI: 10.7326/0003-4819-110-5-353. View

Schoepfer A, Beglinger C, Straumann A, Trummler M, Vavricka S, Bruegger L . Fecal calprotectin correlates more closely with the Simple Endoscopic Score for Crohn's disease (SES-CD) than CRP, blood leukocytes, and the CDAI. Am J Gastroenterol. 2009; 105(1):162-9. DOI: 10.1038/ajg.2009.545. View

Jostins L, Ripke S, Weersma R, Duerr R, McGovern D, Hui K . Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature. 2012; 491(7422):119-24. PMC: 3491803. DOI: 10.1038/nature11582. View

Hillson E, Dybicz S, Waters H, Stuart B, Schaneman J, Dabbous O . Health care expenditures in ulcerative colitis: the perspective of a self-insured employer. J Occup Environ Med. 2008; 50(8):969-77. DOI: 10.1097/JOM.0b013e31816fd663. View

Irvine E, Zhou Q, Thompson A . The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn's Relapse Prevention Trial. Am J Gastroenterol. 1996; 91(8):1571-8. View

Silverstein M, Loftus E, Sandborn W, Tremaine W, Feagan B, Nietert P . Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort. Gastroenterology. 1999; 117(1):49-57. DOI: 10.1016/s0016-5085(99)70549-4. View

Gawande A . The hot spotters: can we lower medical costs by giving the neediest patients better care?. New Yorker. 2011; :40-51. View

Hay J, Hay A . Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992; 14(4):309-17. DOI: 10.1097/00004836-199206000-00009. View

10.

Cohen R, Larson L, Roth J, Becker R, Mummert L . The cost of hospitalization in Crohn's disease. Am J Gastroenterol. 2000; 95(2):524-30. DOI: 10.1111/j.1572-0241.2000.01779.x. View

11.

Feagan B, Vreeland M, Larson L, Bala M . Annual cost of care for Crohn's disease: a payor perspective. Am J Gastroenterol. 2000; 95(8):1955-60. DOI: 10.1111/j.1572-0241.2000.02261.x. View

12.

Ananthakrishnan A, Weber L, Knox J, Skaros S, Emmons J, Lundeen S . Permanent work disability in Crohn's disease. Am J Gastroenterol. 2007; 103(1):154-61. DOI: 10.1111/j.1572-0241.2007.01561.x. View

13.

Yu A, Cabanilla L, Wu E, Mulani P, Chao J . The costs of Crohn's disease in the United States and other Western countries: a systematic review. Curr Med Res Opin. 2007; 24(2):319-28. DOI: 10.1185/030079908x260790. View

14.

Cohen R, Yu A, Wu E, Xie J, Mulani P, Chao J . Systematic review: the costs of ulcerative colitis in Western countries. Aliment Pharmacol Ther. 2010; 31(7):693-707. DOI: 10.1111/j.1365-2036.2010.04234.x. View

15.

Jowett S, Seal C, Barton J, Welfare M . The short inflammatory bowel disease questionnaire is reliable and responsive to clinically important change in ulcerative colitis. Am J Gastroenterol. 2001; 96(10):2921-8. DOI: 10.1111/j.1572-0241.2001.04682.x. View

16.

Hempstead K, DeLia D, Cantor J, Nguyen T, Brenner J . The fragmentation of hospital use among a cohort of high utilizers: implications for emerging care coordination strategies for patients with multiple chronic conditions. Med Care. 2014; 52 Suppl 3:S67-74. DOI: 10.1097/MLR.0000000000000049. View

17.

Harvey R, Bradshaw J . A simple index of Crohn's-disease activity. Lancet. 1980; 1(8167):514. DOI: 10.1016/s0140-6736(80)92767-1. View

18.

Abraham C, Cho J . Inflammatory bowel disease. N Engl J Med. 2009; 361(21):2066-78. PMC: 3491806. DOI: 10.1056/NEJMra0804647. View