Utilization of health care resources by individuals with inflammatory bowel disease in the United States: A profile of time since diagnosis

BACKGROUND: There are no cost studies of inflammatory bowel disease (IBD) that describe its impact on resource utilization or treatment costs over long periods of time. Our aim was to determine if there are observable trends in health-care resource utilization by adults with IBD depending on disease duration. METHODS: The 1999 U.S. National Health Interview Survey (n = 30,801; N = 195,398,057) included 256 adult cases with IBD who indicated the number of years since the onset of disease. Cases were grouped according to the "number of years with IBD" to distinguish between recent diagnosis (0-5 yr with IBD), long-standing IBD (6-15 yr with 11313), and very long-standing IBD (16-62 yr). A group of non-IBD controls was established and age and gender were controlled for through logistic regression analysis. Odds ratios were computed for resource use including hospitalization, health provider contact, and prescription medication. Population estimates were computed, while accounting for the complex survey design. RESULTS: When compared with the general population, IBD patients were more likely to visit a specialist and to use prescription medication regardless of disease duration. GP visits were more likely until 15 yr with diagnosed IBD [0-5 yr with IBD: OR = 2.26; 95% Cl = (1.21-4.21); 6-15 yr with IBD: OR = 2.73; 95% Cl = (1.17-6.37)]. Home care was more likely in the IBD population with long-standing disease [OR = 3.21; 95% Cl = (1.22-8.40)]. An emergency room visit [OR = 2.41; 95% Cl = (1.49-3.88)] and hospitalization [OR = 2.34; 95% Cl = (1.38-3.96)] were more likely in the first 5 yr since diagnosis as was hospitalization and surgical intervention [OR = 2.14; 95% Cl = (1.09-4.19)]. CONCLUSION: Specialist physicians are visited by IBD patients, and prescription medications are provided to treat IBD patients throughout their lives. This is a statistically significant trend that is viewed from onset of the disease to up to 62 yr with IBD. Our results also suggest, at least tentatively, that patients within the first 5 yr after the onset of the disease have a stronger tendency than the general population to visit an emergency room, to be hospitalized, and to have been both hospitalized and to have had surgery. If these results were borne out by further studies, then this would indicate that we can measure the greatest proportion of treatment effects on these resources within a relatively short period.