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Trends and Factors Associated with Hospitalization Costs for Inflammatory Bowel Disease in the United States

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Abstract

Background

Few studies have addressed recent trends in hospitalization costs for inflammatory bowel disease (IBD).

Objective

We explored trends and described patient and hospital factors associated with hospitalization costs for IBD.

Methods

Using data from the 2003–2014 National Inpatient Sample for adults aged ≥ 18 years, we estimated costs using multivariable linear models and assessed linear trends by time periods using piecewise linear regressions.

Results

In 2014, there were an estimated 56,290 hospitalizations for Crohn’s disease (CD), with a mean cost of US$11,345 and median cost of US$7592; and 33,585 hospitalizations for ulcerative colitis (UC), with a mean cost of US$13,412 and median cost of US$8873. Higher costs were observed among Hispanic [adjusted cost ratio (ACR) = 1.07; 95% confidence interval (CI) = 1.00–1.14; p = 0.04] or other non-Hispanic (ACR = 1.09; 95% CI = 1.02–1.17; p = 0.01) CD patients than for non-Hispanic White CD patients. For UC patients, higher costs were observed among men (ACR = 1.09; 95% CI = 1.05–1.13; p < 0.001) compared with women and among patients aged 35–44 years, 45–54 years, and 55–64 years compared with those aged 18–24 years. Among all patients, factors associated with higher costs included higher household income, more comorbidities, and hospitals that were government nonfederal versus private, were large versus small, and were located in the West versus Northeast regions. From 2003 to 2008, total costs increased annually by 3% for CD (1.03; 95% CI = 1.02–1.05; p < 0.001) and 4% for UC (1.04; 95% CI = 1.02–1.06; p < 0.001), but remained unchanged from 2008 to 2014.

Conclusions

The findings are important to identify IBD patients with higher hospitalization costs and to inform policy plans on hospital resource allocation.

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Data Availability Statement

The datasets generated during and/or analyzed during the current study are not publicly available because a Data User Agreement is individually required for HCUP NIS and MarketScan databases, but the software code underpinning the analysis is available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Population Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway NE, Mailstop F-78, Atlanta, GA, 30341, USA

    Fang Xu, Yong Liu, Anne G. Wheaton, Kristina M. Rabarison & Janet B. Croft

Authors
  1. Fang Xu
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  2. Yong Liu
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  3. Anne G. Wheaton
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  4. Kristina M. Rabarison
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  5. Janet B. Croft
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Contributions

Study design: FX, YL, JBC. Study analysis: FX, YL, KMR. Results interpretation: FX, YL, AGW, KMR, JBC. Manuscript writing: FX, YL, AGW, KMR, JBC. Manuscript approval: FX, YL, AGW, KMR, JBC.

Corresponding author

Correspondence to Fang Xu.

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Funding

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflict of Interest

Fang Xu, Yong Liu, Anne G. Wheaton, Kristina M. Rabarison, and Janet B. Croft have no conflict of interest in the study.

Appendix

Appendix

See Tables 3 and 4.

Table 3 Distribution of selected characteristics and hospitalization costs for Crohn’s disease as the first-listed diagnosis among adults aged ≥ 18 years, by selected characteristics: 2014 National Inpatient Sample
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Table 4 Distribution of selected characteristics and hospitalization costs for ulcerative colitis as the first-listed diagnosis among adults aged ≥ 18 years, by selected characteristics: 2014 National Inpatient Sample
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Xu, F., Liu, Y., Wheaton, A.G. et al. Trends and Factors Associated with Hospitalization Costs for Inflammatory Bowel Disease in the United States. Appl Health Econ Health Policy 17, 77–91 (2019). https://doi.org/10.1007/s40258-018-0432-4

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