Prevalence and Financial Burden of Digestive Diseases in a Commercially Insured Population.

Abstract

BACKGROUND AND AIMS\nDigestive diseases represent a diverse group of clinical conditions that impact the population. Their heterogeneity in classification, presentation, acuity, chronicity, and need for drug therapy presents a challenge when comparing and contrasting the burden associated with these conditions. Prior studies use an outdated classification system and aggregate costs at the population level or focus on specific diseases, limiting the ability to characterize the overall landscape. Our aim was to provide the most up to date assessment of cost, utilization, and prevalence associated with digestive diseases METHODS: We examined digestive disease claims and payment data for a commercially insured adult population between 2016-2018 to provide a comprehensive summary of costs, utilization, and prevalence across 38 conditions. Outcome variables included: point prevalence and relative prevalence; annualized all-cause medical and drug costs; digestive disease-specific average medical cost; digestive disease-specific cost per fill; and utilization by clinical setting and by clinical condition.\n\n\nRESULTS\nA total of 7,297,435 individuals with a digestive disease diagnosis were included in the study. The point prevalence of having a digestive disease in the total population was 24%. Annualized total costs by clinical category ranged from $10,038 (eosinophilic esophagitis) to $107,007 (hepatitis C) with medical costs accounting for most of the expenditures in a majority of conditions. Annualized total costs for common conditions included, $39,653 alcoholic liver disease, $42,554 for acute pancreatitis, $62,735 for Crohn s disease, $13,948 for functional GI disorders, $53,214 for non-alcoholic cirrhosis, and $36,441 for ulcerative colitis. Average cost of inpatient stays ranged from $12,218 (noninfectious gastroenteritis/colitis) to $78,259 (NASH). Outpatient visits ranged from $784 (GI infection) to $4,629 (gallbladder and biliary tract disease). Average drug cost per fill ranged from $83 (GERD) to $1,458 (hepatitis C). A total of 27,429,046 clinical encounters occurred across all conditions during the study period, with 90% taking place as outpatient visits. Abdominal pain was the single largest contributor to outpatient visits and ED to home encounters. Inpatient stays were considerably more heterogeneous with no condition accounting for more that 12% (gallbladder and biliary tract disease) of the total.\n\n\nCONCLUSION\nThe results demonstrate digestive diseases are common, heterogeneous in cost and utilization, and collectively exact a significant financial burden on the US adult population.