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• W2912061184 abstract "Introduction: Patients with inflammatory bowel disease (IBD) with depression and other psychosocial issues such as chronic pain experience poorer health outcomes and quality of life. We sought to examine if these issues also predicted higher utilization of emergent health services and higher cost. Methods: A retrospective cohort study using the Truven Health Marketscan Databases from 2009-2010, which capture clinical utilization across inpatient and outpatient settings, including outpatient drug claims, for subjects with employer-based health insurance was performed. Patients who experienced an encounter with a primary diagnosis of IBD during 2009 were extracted. Details regarding demographics, comorbidities, procedures, immunomodulators, biologics, corticosteroids, benzodiazepines, and opioids were obtained. Outcomes for the year 2010 included number of emergent encounters and being in the top quartile of cost. Negative binomial regression was used to examine the association between potential predictors and number of emergent encounters, and logistic regression was used to examine being in the top quartile of cost. Lasso logistic regression with cross-validation was used to generate a predictive model trained on half of the data, and subsequently tested on the other half. Results: 76,171 patients were included in the study. Mean age was 45.3, with 54.6% female. Depression was present in 28%. 16.6% of patients were on a benzodiazepine and 35.7% were on an opioid. Adjusting for covariates, depression was associated with a higher incidence of an emergent encounter (IRR 1.3, 95%CI 1.3-1.4) and higher odds of being in the top quartile of cost (OR 1.3, 95%CI 1.3-1.4) in 2010, as was high opioid use (IRR 3.1, 95%CI 2.8-3.5) (OR 2.6, 95% CI 2.4-2.7), and high benzodiazepine use (IRR 1.3, 95%CI 1.2-1.4) (OR 1.3, 95%CI 1.3-1.4). The results of the lasso logistic regression indicated that the top predictors of the cost outcome were treatment with biologic agent, opioid use, corticosteroid use, diabetes, small bowel surgery, CD, and depression. The AUC for the predictive model for the cost outcome on the test data was 0.72 (Figure).Figure: Area under the receiver operating characteristic curve (AUC) for the predictive model for being in the top quartile of costs in 2010.Conclusion: In this analysis of IBD patients in a large, administrative claims database, depression, opioid use, and benzodiazepine use in 2009 were associated with a higher incidence of emergent encounters and were significant predictors of being in the top quartile of cost in 2010. Proper management of psychosocial issues is integral to the management of patients with IBD." @default.
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• W2912061184 date "2017-10-01" @default.
• W2912061184 modified "2023-09-27" @default.
• W2912061184 title "Depression and Opioid Use in Patients With Inflammatory Bowel Disease Predict Higher Incidence of Emergent Encounters and Cost in the Subsequent Year: Analysis of MarketScan Claims Data" @default.
• W2912061184 doi "https://doi.org/10.14309/00000434-201710001-00665" @default.
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