P097 Economic Burden of Inpatient and Emergency Department Care of Inflammatory Bowel Disease: National Trends in the United States
Authors: Tetangco Eula , Rassameehiran Supannee , Sifuentes Humberto 
Published: December 2019

BACKGROUND:
Crohn's disease (CD) and ulcerative colitis (UC) are collectively known as inflammatory bowel disease. The chronic relapsing nature of this condition places substantial health and financial burdens on the United States population. This study aims to analyze trends in emergency room visits, admission rates, length of stay, and hospital charges for CD and UC based on a national sample from 1993-2014.

METHODS:
Hospitalization and emergency department data for CD and UC from were obtained from the National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project (HCUP). The NIS contains data from more than 7 million hospital stays each year and is the largest publicly available database of all-payer inpatient health care in the United States. The NEDS is its counterpart for the emergency department, containing data from approximately 31 million ED visits each year. Extracted data concerned principal discharge diagnoses of Crohn’s disease (ICD-9 555.x) and ulcerative colitis (ICD-9 556.x) in adults. Statistical significance of the difference in emergency department visits, hospital discharges, length of stay, hospital charges, and in-hospital mortality over the years was determined by chi square test for trends.

RESULTS:
From 2006-2014, emergency department (ED) visits have increased for both phenotypes (P = 0.005). Admissions from the ED to the same hospital also increased for both CD (P = 0.012) and UC (P = 0.006), as did discharges from the ED (P = 0.005 for both), correlating with the increase in ED visits. From 1993-2014, the number of hospitalizations with a primary discharge diagnosis of CD or UC increased from 35,576 to 61,805 patients and from 23,106 to 37,565 patients respectively (<0.001). However, when comparing data from 2006 to 2014 (an era when anti-tumor necrosis factor agents were approved by the Food and Drug Administration and widely available for both CD and UC), the rates of hospitalizations did not change significantly. In this same time period, admission rates for IBD decreased significantly in the states of Illinois (P = 0.047) and Vermont (P = 0.008). Mean charges per hospital stay, adjusted for inflation, increased dramatically from $20,978.30 in 1993 to $38,223.50 in 2014 for CD and from $24,701.20 to $45,464.70 for UC < 0.001). Meanwhile, mean length of stay decreased from 8 to 5 days for CD and from 9 to 5 days for UC (<0.001). Additionally, in-hospital mortality decreased from a rate of 0.65 to 0.21 for CD and from 1.42 to 0.37 for UC (<0.001).

CONCLUSION(S):
Over the course of more than a decade there has been a significant increase in the number of ED visits and inpatient admissions for IBD, along with an increase in cost. However, significant decreases in the length of stay and in-hospital mortality may reflect improved care and advancements in the treatment of IBD. Further studies on strategies that prevent complications prompting ED visits and hospital admissions are warranted.