Lung-Yi Mak1, Siew C Ng2, Irene O L Wong3, Michael K K Li4, F H Lo5, Marc T L Wong6, C M Leung7, Steven W C Tsang8, K H Chan9, S F Sze10, Edwin H S Shan11, Belsy C Y Lam12, Aric J Hui13, Ivan F N Hung1, Wai K Leung1. 1. Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong. 2. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. 3. School of Public Health, University of Hong Kong, Hong Kong. 4. Department of Medicine, Tuen Mun Hospital, Hong Kong. 5. Department of Medicine, United Christian Hospital, Hong Kong. 6. Department of Medicine, Princess Margaret Hospital, Hong Kong. 7. Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong. 8. Department of Medicine, Tseung Kwan O Hospital, Hong Kong. 9. Department of Medicine, North District Hospital, Hong Kong. 10. Department of Medicine, Queen Elizabeth Hospital, Hong Kong. 11. Department of Medicine, Caritas Medical Center, Hong Kong. 12. Department of Medicine, Kwong Wah Hospital, Hong Kong. 13. Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong.
Abstract
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.
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.