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ORLANDO -- While there was a significant increase in emergency department visits and an increase in cost for treating patients with inflammatory bowel disease, there were also significant declines in length of stay and in-hospital mortality, according to national data reported here.
Visits to the emergency department increased by 32% for Crohn's disease and by 38% for ulcerative colitis from 2006 to 2014, while both conditions experienced a 45% increase in mean charges per hospital stay from 1993 to 2014, reported Eula Tetangco, MD, of Medical College of Georgia at Augusta University.
However, from 1993 to 2014, mean length of stay declined to 5 days for both Crohn's disease and ulcerative colitis (from 8 and 9 days, respectively), while in-hospital mortality also dropped for both conditions.
At a presentation at the Advances in Inflammatory Bowel Diseases meeting, Tetangco noted that the "chronic relapsing nature" of inflammatory bowel disease means "substantial health and financial burdens" for the U.S.
Session co-moderator Miguel Regueiro, MD, of the Cleveland Clinic Lerner College of Medicine, who was not involved with the research, noted that relatively few patients account for much of the resource utilization.
"All of us from a practical standpoint see that in our practice -- 10%-20% of patients may occupy utilization for the majority of the group," he said.
Tetangco and colleagues examined data from the National Inpatient Sample and Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project, which was based on ICD-9 codes, to look more closely at a variety of healthcare trends relating to inflammatory bowel disease.
From 1993 to 2014, the number of total hospital discharges with a primary diagnosis of Crohn's disease had a significant increase of 45% and the total number with a primary diagnosis of ulcerative colitis increased by 40%. In 2014, mean charges per hospital stay hit about $38,000 for Crohn's disease, and about $45,000 for ulcerative colitis.
In 2014, the rate of in-hospital mortality was down to 0.21 per 100,000 for Crohn's disease and 0.37 per 100,000 for ulcerative colitis -- a significant decline from 1993 and rates of 0.67 per 100,000 and 1.42 per 100,000, respectively.
Tetangco also noted a milestone during the 2006 to 2014 time period -- that anti-tumor necrosis factor agents became widely available to treat both Crohn's disease and ulcerative colitis.
"A significant decrease in the length of stay and in-hospital mortality may reflect improved care and advancements for the treatment of IBD," she said.
However, Tetangco noted that rates of hospitalization did not change significantly during that time.
Admission rates for inflammatory bowel disease as the primary diagnosis declined in two states (Illinois and Vermont) during that time, but clinicians commenting after the presentation suggested that could be due to chance.
"Further studies on strategies that prevent complications prompting ED visits and hospital admissions are warranted," Tetangco concluded.
Disclosures
The authors disclosed no conflicts of interest.
Primary Source
Advances in Inflammatory Bowel Disease
Tetangco E, et al "Economic Burden of Inpatient and Emergency Department Care of Inflammatory Bowel Disease" AIBD 2019; Abstract P097.