Patients With Celiac Disease Incur Significantly Higher Direct Costs
Washington, DC—Patients with celiac disease, particularly those whose disease is uncontrolled, incurred significantly higher all-cause direct costs compared with matched controls, according to results of a retrospective claims analysis presented during Digestive Disease Week by Stefano Guandalini, MD, professor of pediatrics, section chief of pediatric gastroenterology, hepatology, and nutrition, founder and medical director of University of Chicago Celiac Disease Center, University of Chicago.
The increased costs, he explained, are likely due to an increase in comorbidities in these patients, including osteoporosis, iron-deficient anemia, and thyroid disease. Higher costs are more prevalent in those with celiac disease even when they eat a gluten-free diet.
Celiac disease affects approximately 1% of the population in Western countries, causing small intestinal mucosal injury. Patients may also experience gastrointestinal symptoms such as abdominal pain, diarrhea, and bloating. Few studies, however, have evaluated the cost burden associated with celiac disease.
One study showed patients with celiac disease had higher total costs vs controls, with excess costs concentrated among male patients. Another study found that higher health care costs among celiac patients vs controls were driven by increased referrals and laboratory testing before diagnosis, as well as prescription drug and gluten-free food costs after diagnosis. Therefore, studies to assess health care costs among patients with controlled and uncontrolled celiac disease were needed to better understand the factors that drive excess costs.
Dr Guandalini and colleagues conducted a retrospective, matched case- control study over a 12-month period using administrative claims data from 1998 to 2013. The objectives were to etimate the excess direct costs in patients with celiac disease vs patients without celiac disease and to estimate possible differences in direct costs between patients with controlled vs uncontrolled celiac disease. To be eligible for study inclusion, patients had to have at least 1 claim for celiac disease, be continuously enrolled in a health plan for at least 1 year before the study period, and 64 years of age or younger. A total of 12,187 patients were ultimately selected and matched to controls (for such variables as age, sex, etc). About two-thirds of the study population were female and one-third were male, with an average age of 39 years; 18% were between 0 and 18 years of age, and about 50% were between 45 and 64 years of age. Charlson Comorbidity Index (CCI) scores indicated an increased number of comorbidities in patients with celiac disease. Among the total of 12,187 patients, 10,181 (83%) had controlled celiac disease, defined as no hospitalizations, no emergency department visits, and ≤1 outpatient/ dietician visits; 2006 patients (17%) had uncontrolled celiac disease, which meant patients did not meet the controlled criteria.
The primary outcome of the study was all-cause direct costs, which were calculated for the 1-year study period and adjusted to 2013 US dollars. Costs were compared between all celiac disease patients vs matched controls, and controlled celiac disease cases vs matched controls.
Results demonstrated that all-cause direct costs in patients with uncontrolled celiac disease were 3.8 times the cost of matched controls (P<.0001) (Table). Medical costs among all celiac patients were 2.6 times higher than matched controls (P<.0001), and outpatient costs were 2.5 times higher among controlled celiac patients than their matched controls (P<.0001). Inpatient costs were 5.4 times higher among uncontrolled celiac cases than matched controls (P<.0001) and celiac-related costs were 6.1 times higher in patients with uncontrolled vs controlled celiac disease. Inpatient costs were 6 times higher in uncontrolled cases compared with all celiac cases, representing 59% of the total costs among uncontrolled celiac patients: of $4189, $2476 were for inpatient costs, compared with $408 of the total cost for all celiac patients.
The researchers also compared costs with those for ulcerative colitis. According to Dr Guandalini, “Although ulcerative colitis costs were slightly higher than those for all celiac patients ($15,378 compared with $12,217), quite surprisingly, costs related to uncontrolled celiac patients ($18,206) were higher than those for ulcerative colitis.”
Limitations of the study included the inability to assess patients’ celiac symptoms with claims data; and because data focused on privately insured patients, results may not be generalizable to those who are uninsured or covered by other payers.—Mary Mihalovic
