The Cost of Crohn's Disease: Varied Health Care Expenditure Patterns Across Distinct Disease Trajectories

Background: Patients with Crohn's disease (CD) encompass a heterogeneous disease spectrum, with variable health care utilization and expenditure patterns. Lemann Index (LI) is a metric that quantifies cumulative bowel damage and has shown utility in delineating distinct disease phenotypes. We aimed to characterize the financial burden from all medical care in CD cohort in relation to the variations in LI-based disease phenotypes. Methods: CD patients with 5-year (y) follow-up from a prospective registry were included. LI was calculated from first (LI1) and last (LI2) clinical encounters. Change in score (LI2-LI1) or Delta LI (DLI) was used for association analysis with health care expenditures. Results: A total of 243 patients with CD formed the study population (median age, 44 years; 58% women; median disease duration 12 years). DLI was used to define disease trajectories: DLI <0 (indicating improving bowel damage); DLI = 0 (stable); DLI >0 (worsening); which comprised 15.6%, 30.9%, and 53.5% of the cohort, respectively. Patients with DLI >0 had significantly higher CD-related surgeries, health care utilization, medication (steroids and biologics) use as well as higher median 5 years total and stratified charges compared with the other groups. Total 5-year expenditure was $56 million; 67% of which was related to hospitalization. Total expense showed independent positive correlation with LI2 (P = 0.001) and DLI (P = 0.001), and negative correlation with age (P = 0.029) and 5-year quality of life score (P = 0.024). Conclusions: The financial burden of CD is significantly associated with worsening bowel damage. Further research should focus on the prediction and management of the costliest/sickest patients with CD.