Jennifer H. Lofland

Objective: To estimate indirect costs associated with rheumatoid arthritis (RA). Methods: This was a retrospective study using 1996–2006 US Medical Expenditure Panel Survey data. Employed individuals were aged 18 to 65 years. A two-part model estimated the probability of time lost from work and annual number of workdays missed due to illness. Results: Sixty-seven percent (209/312) of RA individuals missed work versus 58% (52,046/89,734) of those without RA (P = 0.0007). Among individuals who missed work, those with RA missed more workdays annually than those without RA ( = 13.659, 9.879, respectively; P = 0.008). Incremental per capita costs in annual lost workdays between those with and without RA were $596. Estimated national indirect costs of RA-related absenteeism were $252 million annually. Conclusions: Individuals with RA have higher probabilities of missing work and missing workdays than those without RA.

Limited information is available on patients’ perspectives of shared decision-making practices used in inflammatory bowel disease (IBD). The aim of this study was to examine patient insights regarding shared decision making among patients with IBD using novel statistical technology to analyze qualitative data. Two 10-patient focus groups (10 ulcerative colitis patients and 10 Crohn’s disease patients) were conducted in Chicago in January 2012 to explore patients’ experiences, concerns, and preferences related to shared decision making. Key audio excerpts of focus group insights were embedded within a 25-min online patient survey and used for moment-to-moment affect trace analysis. A total of 355 IBD patients completed the survey (ulcerative colitis 51 %; Crohn’s disease 49 %; female 54 %; 18–50 years of age 50 %). The majority of patients (66 %) reported increased satisfaction when they participated in shared decision making. Three unique patient clusters were identified based on their involvement in shared decision making: satisfied, content, and dissatisfied. Satisfied patients (18 %) had a positive physician relationship and a high level of trust with their physician. Content patients (48 %) had a moderate level of trust with their physician. Dissatisfied patients (34 %) had a life greatly affected by IBD, a low level of trust of their physician, a negative relationship with their physician, were skeptical of decisions, and did not rely on their physician for assistance. This study provides valuable insights regarding patients’ perceptions of the shared decision-making process in IBD treatment using a novel moment-to-moment hybrid technology approach. Patient perspectives in this study indicate an increased desire for shared decision making in determining an optimal IBD treatment plan.

Background There is limited information on gastroenterologists’ perspectives of shared decision making (SDM) in discussions of therapeutic agents with inflammatory bowel disease (IBD) patients. Aims To examine gastroenterologists’ perspectives about SDM with IBD patients, using a novel statistical hybrid approach to analyze qualitative data. Methods Physician interviews and online surveys were conducted from a panel of gastroenterologists in April 2012. Gastroenterologists were asked about their barriers to SDM, SDM practices, relationship to their patients, knowledge of SDM, and insights into SDM implementation. Key audio excerpts adapted from the interviews were used for moment-to-moment affect trace analysis in an online survey. Cluster analysis was used to segment gastroenterologists into mutually exclusive provider groups. Results One hundred and six gastroenterologists completed the survey (88 % male; 55 % ≤ 50 years of age). Over three-fourths of gastroenterologists were familiar with SDM (77 %). The vast majority of gastroenterologists (80 %) tried to use a form of SDM with their patients; only 12 % stated that they have a systematic, consistent, and formally documented approach to SDM. Three unique physician clusters were identified: SDM Believers (20 %, n = 20); SDM Skeptics (47 %, n = 47); and SDM Enthusiasts (34 %, n = 34). The three key barriers to practicing SDM were lack of the following: time (74 %), reimbursement (70 %), and tools (51 %). Twenty-two percent of gastroenterologists do not currently use SDM tools. Conclusions Gastroenterologists lack the systematic approaches and tools for implementing SDM within their IBD practices. These data offer a foundation for future research in developing and testing SDM programs for gastroenterologists and their IBD patients.

Biologic therapy has been shown to be effective in achieving and maintaining remission in the treatment of inflammatory bowel disease (IBD). However, their impact on healthcare resource utilization is not well understood. This study explored the impact of biologic use on IBD-related hospital admissions and emergency room visits and healthcare expenditures.This study used a retrospective cohort design to analyze data from the MarketScan Commercial and Medicare databases (Truven Health Analytics Inc.) for the years 2006-2010. Patients were identified using ICD-9 diagnosis codes for IBD and age 18 or older at time of initial diagnosis. Linear models were used to predict the probability of an IBD-related hospitalization or ER visit and healthcare expenditures with binary variables indicating use of biologics in the current year and in the previous 2 years, as well as patient- and area-level control variables.Patients using biologics in the current year were 14.1-17.6% more likely to be hospitalized for IBD. However, biologic use in the previous year was associated with a 3.8-5.6% reduction in hospitalizations, and biologic use 2 years prior was associated with a 1-2.8% reduction in hospitalizations in the current year. Similar results are found for ER visits. All indicators for biologic use were associated with increased expenditures.There was a negative association between lagged use of biologics and the proportion of patients with IBD-related hospitalizations and ER visits. This finding may suggest that increased use of biologics over time is associated with a decrease in IBD-related healthcare utilization.

Objective: To estimate indirect costs associated with inflammatory bowel disease (IBD). Methods: This was a retrospective study using 1996 to 2006 US Medical Expenditure Panel Survey data. Employed individuals were aged 18 to 64 years. A two-part model estimated the probability of time lost from work because of illness and the annual number of workdays missed. Results: A total of 71.5% (143/200) and 58.2% (52,257/89,846) of individuals with and without IBD, respectively, missed time from work because of illness (P = 0.0001). Among individuals who missed work, those with IBD missed more workdays annually than those without IBD ( = 13.38, 9.89, respectively; P = 0.044). Incremental per capita cost in annual lost workdays between those with and without IBD was $783. National indirect IBD-related costs were $249 million annually. Conclusions: Individuals with IBD have higher probabilities of missing time from work and missing workdays than those without IBD.

(2013). Cost-per-remission analysis of infliximab compared to adalimumab among adults with moderate-to-severe ulcerative colitis. Journal of Medical Economics: Vol. 16, No. 4, pp. 461-467. doi: 10.3111/13696998.2013.775134

Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, debilitating conditions that can have important economic and clinical implications. To quantify individual and national estimates of the health care and patient out-of-pocket (OOP) costs of CD and UC. In a retrospective study using 1996 to 2009 data from the Medical Expenditure Panel Survey, individuals’ self-reported health conditions were mapped to International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Individuals with a code of 555.x (CD) or 556.x (UC) were identified. Health care services and costs included prescriptions and inpatient, outpatient, emergency room, office, and home health services. OOP costs were the portion of individuals’ total payments for health care services. There were 358 individuals with CD (mean age 49.0 years; 55 % female), 198 individuals with UC (mean age 47.1 years; 64 % female), and 206,993 individuals without inflammatory bowel disease (IBD) (mean age 48.2 years; 58 % female). Annual per capita health insurer and OOP costs for individuals with CD were greater than those without IBD ($9,526 versus $3,781, p < 0.001 and $1,603 versus $866, p < 0.001, respectively). Health insurer and OOP costs were greater for UC compared with those without IBD ($6,443 versus $3,781, p < 0.001 and $1,263 versus $866, p < 0.001, respectively). US national aggregate annual estimates of health insurer, OOP, and total direct costs secondary to CD are $2.04 billion, $0.26 billion, and $2.29 billion, respectively. Aggregate health insurer, OOP, and total direct costs attributable to UC are $0.53 billion, $0.07 billion, and $0.61 billion, respectively. The direct costs associated with CD and UC are substantial. The extent to which appropriate diagnosis and treatment reduces the total health care costs for individuals with CD or UC should be examined.

Psoriasis is a chronic inflammatory disease that can significantly affect quality of life. Effective communication between health care providers and patients is important for managing psoriasis, and sociolinguistic analysis is a validated method for researching physician–patient interactions. To characterize current in-office communication patterns and to identify potential ways in which such interactions may be improved regarding quality of life, we studied the in-office discussions between 24 patients with psoriasis and their physicians using audio and video recordings. Although many physicians acknowledged the effect of psoriasis on quality of life, few discussed this aspect of the disease with patients. This study offers a foundation for additional research examining communication strategies between patients with psoriasis and their health care providers.

Objective: To quantify individual and national estimates of direct medical costs of psoriasis and similar disorders using national survey data. Methods: This was a retrospective study using 1996–2006 data from the Medical Expenditure Panel Survey (MEPS). Individuals' self-reported current health conditions were mapped to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes, whereby individuals with code 696 were categorized as having psoriasis. Healthcare services, for which healthcare costs were collected, included prescriptions and inpatient, outpatient, emergency room, office, and home health services. Out-of-pocket (OOP) costs were the portion of individuals' total payments for healthcare services. Results: There were 873 individuals with psoriasis (mean age = 51 years; 52% female) and 160 617 individuals without psoriasis (mean age = 48 years; 58% female). Annual per capita healthcare and OOP costs for individuals with psoriasis exceeded those for individuals without psoriasis ($4547 vs $3793, p < 0.001; $1255 vs $913, p < 0.001, respectively). United States national annual estimates of healthcare, OOP, and total direct medical expenses for psoriasis were $3.67 billion, $1.49 billion, and $5.17 billion, respectively. Conclusions: Direct medical costs associated with psoriasis are substantial to healthcare payers and patients. The extent to which appropriate and early diagnosis and treatment reduce total healthcare costs for individuals with psoriasis should be examined.

Plaque psoriasis is a chronic, inflammatory skin disease that can be difficult to treat. Traditional systemic agents, topical agents, phototherapy and biologic therapies can be used for patients with psoriasis. The authors reviewed published results from a variety of sources in order to better understand the effects of psoriasis treatments on patient satisfaction, patient adherence, healthcare resource utilization and productivity. Patients with psoriasis consider many factors when evaluating therapies, including the time for the therapy to be effective, cosmetic issues common with topical therapies and travel to and from phototherapy centers. Satisfaction with and adherence to biologic therapies appears to be greater than for traditional therapies. Although biologic therapies are generally more expensive than are traditional, these agents may contribute to decreased healthcare utilization and increased productivity.