According to the data from a recent study, presented at Crohn’s and Colitis Congress recently, Americans are incurring dramatically increased costs associated with inflammatory bowel disease over the past 20 years. While pharmaceutical costs (primarily biologic drugs) increase at a rapid rate, actual costs associated with the utilization of inpatient services decreased.
Inflammatory Bowel Disease
Inflammatory Bowel Disease (IBD) represents a group of inflammatory conditions of the colon and small intestine. Crohn’s disease and ulcerative colitis are the principal types of inflammatory bowel disease. While Crohn’s disease affects the small intestine and large intestine, as well as mouth, esophagus, stomach and the anus, ulcerative colitis primarily impacts the colon and the rectum. Falling under the category of Gastroenterology, about 11.2 million people worldwide are afflicted with this condition while an estimated 47,400 deaths occur due to the disease.
According to the U.S. Center for Disease Control and Prevention (CDC), approximately 3 million people were diagnosed with IBD in 2015 as compared to 2 million in 1999—a huge increase.
Led by Benjamin Click, MD and gastroenterologist at Cleveland Clinic, and study colleagues utilized The Medical Expenditure Panel Survey (MEPS), a nationally representative database of health care utilization and expenditure data collected for the past 22 years. Ryan McDonald with Healio reported that Dr. Click and team found that median per-patient annual health care expenditure in patients with IBD was $6,570 as compared to $4,010 in patients with rheumatoid arthritis across the study. Total annual spending increases 2.2 times over the study period and was 36% higher in IBD over RA. Moreover, pharmaceutical spending increased fourfold and become the largest cost category. Interestingly at the same time inpatient costs decreased by 40% during the study period.
Patients Spend More on Pharmaceuticals at Faster Rates
Dr. Click with Cleveland Clinic was quoted by Healio that “The cost of caring for inflammatory bowel disease has more than doubled over the last 20 years.” He continued, “Looking back at the early time period, health care utilization accounted for the majority of expenditures, but over the course of the study we saw a significant increase in pharmaceutical spending. With that concurrent increase in pharmaceutical spending, we actually saw a reduction in inpatient-related costs. It raises the question whether by utilizing more biologics, we are actually driving down inpatient health care spending?”
Click and team suggest that the trends may be the same with other inflammatory disease. He continued, “The overall health care cost for caring for this patient population is increasing at a rapid rate and we need to focus and determine what are some potential strategies for managing these expenditures and how we can improve upon our care algorithms to better reign in overall cost of care.”
Can Lifestyle Modification be as Effective as Medication?
An interesting trend—a rapid increase in costs and associated payer/patient spend with a simultaneous decrease in inpatient health utilization possibly implying that while the traditional health care provider receives a shrinking percentage of the rapidly growing IBD patient spend, the biopharmaceutical company portion increases at a fast rate.
Rapid modernization and globalization, with transformational changes in food production, distribution and consumption as well as lifestyle changes (less exercise, more sedentary activity) plus a range of other factors contribute to increased IBD occurrence many posit. The growth in IBD occurrence just happen to coincide with the biologic medicine breakthroughs of the past couple decades.
Hence the growth in drug spending undoubtedly is associated with the advent of powerful biologic drugs prescribed for IBD such as Infliximab (Remicade®), Adalimumab (Humira®) and Certolizumab Pego (Cimzia®). These treatments, powerfully advanced in how they work, can save lives and in many cases are absolutely essential.
According to the Mayo Clinic, the root cause of IBD is multifaceted but food choices, stress and other elements associated with lifestyle and genetics are a factor. The growing number of IBD patients equates to a large payment to a select few biopharmaceutical companies with the most compelling products.
But are there alternatives that can help patients save money? According to a number of studies modifying lifestyle may positively impact IBD symptoms. In a Korean-based study, researchers from prominent centers suggest that lifestyle modification may be as important as medication but more study is needed. In the United Kingdom, NICE Clinical Guidelines, No.61 in conjunction with the National Collaborating Centre for Nursing and Supportive Care, suggest diet and lifestyle may be factors that trigger or exacerbate symptoms of IBD. In another Korean observational study (military personnel), the investigators found that lifestyle modification may be effective in managing IBD patients.
Recently investigators from Umm al-Qura University, Saudi Arabia studied dietary changes involving 1,202 study participants. The result: some foods increase IBD symptoms and, overall, making changes to what patients eat may improve conditions for them.
As IBD diagnosed cases rise so does the expenditure for powerful biologic medications that are prescribed for such conditions. In some cases, these medications are absolutely required and literally can save a life. In other cases, perhaps other alternative approaches—including lifestyle and dietary modifications—could be considered as the patient/consumer considers where they can simultaneously reduce symptoms and spend.
Benjamin Click, MD
Call to Action: Do you or a loved one have a diagnosis involving IBD? Check out patient advocacy at the Crohn’s & Colitis Foundation. Learn more about how you can make lifestyle changes to improve, where possible, the condition from your physician and medical specialists associated with credible advocacy groups.