Healthcare resource utilization and cost trends in pediatric inflammatory bowel disease within an accountable care organization.

Abstract

Objective: Healthcare utilization and costs for the inflammatory bowel disease (IBD) population continue to rise nationally. We aimed to describe healthcare utilization and cost trends in children and adolescents with IBD within a pediatric Medicaid accountable care organization (ACO).

Methods: Cross-sectional analysis of inpatient and outpatient insurance claims of known patients with IBD at a single center, also enrolled in a regional ACO. Healthcare utilization and costs were assessed by the total number of different types of healthcare encounters and associated claims on a per-year basis.

Results: We used data from claims incurred by 269 unique patients between October 2015 and December 2020. Total encounters and costs remained stable apart from a notable decrease in encounters in 2020 (likely related to the COVID-19 pandemic). Proportion of outpatient and inpatient encounter types remained stable, with greater than 94% of encounters being outpatient and 1%-2% inpatient. emergency department (ED) encounters decreased significantly from 141 total ED encounters (5% of encounters) in 2016 to 66 (3%) in 2020. Gastrointestinal surgical encounters remained consistent; however, the costs associated more than doubled from $189,970 (8%) in 2016 to $404,793 (19%) in 2020. Total costs from IBD-related infusion encounters increased from $693,440 (29% of total claims costs) in 2016, to $1,241,089 (60%) in 2020 (p < 0.001). Biosimilar use increased rapidly during our study period with a relative decrease in IBD-related infusion costs.

Conclusions: Consistent with adult data, IBD-related infusion encounters are a primary driver of healthcare utilization and cost in pediatric IBD. Biosimilars offer an opportunity to decrease these costs.