Outcomes in patients with IBD stratified by risk of disease progression.

Abstract

Objectives: Risk stratification of patients with Crohn disease (CD) and ulcerative colitis (UC) may improve outcomes and health care resource utilization (HCRU). We characterized patients with CD or UC as being at high or low risk of disease progression and estimated rates of CD-related and UC-related HCRU.

Study design: This retrospective study used claims data from a US health care payer database from January 1, 2017, to December 31, 2019.

Methods: Included patients were fully insured, were 18 years or older, had a diagnosis of CD or UC, and were naive to biologic treatment. Patients were stratified as being at high or low risk of disease progression and associated HCRU using a priori definitions based on American Gastroenterological Association criteria.

Results: For CD, 1459 (39.1%) patients were high risk and 2272 (60.9%) patients were low risk. High-risk patients had higher mean hospitalizations (0.35 vs 0.28; P = .03) and surgeries (0.04 vs 0.01; P < .0001) per patient than low-risk patients. During follow-up, 13.8% of patients with CD at high risk received advanced therapy vs 4.8% of low-risk patients. For UC, 2215 (40.4%) patients were high risk and 3270 (59.6%) patients were low risk. High-risk patients had higher mean hospitalizations (0.33 vs 0.10; P < .0001) and surgeries (0.01 vs 0.00; P < .0001) per patient than low-risk patients. During follow-up, 7.7% of patients with UC at high risk received advanced therapy vs 1.8% of low-risk patients.

Conclusions: Health care claims data may be used for prognostic risk stratification in CD and UC and to identify patients who may benefit from early treatment with advanced therapies.