P326 An exploratory analysis of the impact of COVID-19 on colonoscopy procedures and new biologic treatment initiation among patients with Inflammatory Bowel Disease in the United States

Abstract Background Patients with inflammatory bowel disease (IBD) require frequent colonoscopies to optimize disease management and treatment strategies. At the onset of the COVID-19 pandemic, many routine procedures were postponed to reduce the overall burden on healthcare systems. We characterized the impact of COVID-19 on IBD care by conducting an exploratory analysis of real-world US healthcare claims data to identify changes in treatment patterns and the number of colonoscopy procedures performed in patients with IBD during the first wave of the pandemic. Methods De-identified, open-source health insurance claims data, from Jan 2019 to Oct 2020, were obtained from the Symphony Health Integrated Dataverse® for US adults aged 18–80 years with IBD. Four outcome measures were used: number of colonoscopies performed; number of new biologic treatment initiations or treatment switches; number of new biologic treatment initiations or treatment switches in patients who had a colonoscopy within the previous 60 days; and rate of telehealth consultations per 1000 patients per month. Results During Jan–Dec 2019 and Jan–Oct 2020, 1.54 million and 1.29 million patients with IBD, respectively, were included. The bimonthly number of colonoscopies remained stable throughout 2019, with a maximum change of +5.4% in Jul–Aug (N = 49947) vs Jan–Feb 2019 (N = 47399). Colonoscopy use decreased by 4.7% in Jan–Feb 2020 (N = 45167) vs the same period in 2019. In Mar–Apr 2020, colonoscopy numbers decreased by 55.3% (N = 20191) vs Jan–Feb 2020 (Figure 1a); a reduction of 59.4% vs Mar–Apr 2019 (N = 49780). In May–Jun 2020 (−23.8%) and Jul–Aug 2020 (+2.0%) the difference vs Jan–Feb 2020 gradually decreased (Figure 1a). Bimonthly numbers of new treatment initiations or treatment switches in 2019 varied by up to 6.9% vs Jan–Feb 2019. In May–Jun 2020, numbers of new treatment initiations or treatment switches decreased by 17.0% (N = 10072) vs Jan–Feb 2020 (N = 12133) (Figure 1b); a decrease of 19.3% vs May–Jun 2019 (N = 12488). The number of new treatment initiations or treatment switches in patients who had a colonoscopy within the previous 60 days decreased by 42.5% (N = 892) in Mar–Apr 2020 vs Jan–Feb 2020 (N = 1551) (Figure 1c); a decrease of 44.2% vs Mar–Apr 2019 (N = 1599). Telehealth utilization increased in March 2020 and remained higher than in 2019 up to October 2020 (Figure 2). Conclusion Reduction in colonoscopies and subsequent initiation/switching of treatments during the COVID-19 pandemic first wave suggests lost opportunities for therapy optimization that may have an impact on longer-term patient outcomes. Increased utilization of telehealth services may have helped address gaps in routine clinical care.

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Mental Health Costs of Inflammatory Bowel Diseases

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa030 ◽

2020 ◽

Vol 27 (1) ◽

pp. 40-48 ◽

Cited By ~ 2

Author(s):

Eva Szigethy ◽

Sean M Murphy ◽

Orna G Ehrlich ◽

Nicole M Engel-Nitz ◽

Caren A Heller ◽

...

Keyword(s):

Mental Health ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Claims Data ◽

The United States ◽

Cost Of Care ◽

Medical Utilization ◽

Administrative Claims ◽

Inflammatory Bowel ◽

Ed Visits

Abstract Background Mental health diagnoses (MHDs) were identified as significant drivers of inflammatory bowel disease (IBD)-related costs in an analysis titled “Cost of Care Initiative” supported by the Crohn’s & Colitis Foundation. In this subanalysis, we sought to characterize and compare IBD patients with and without MHDs based on insurance claims data in terms of demographic traits, medical utilization, and annualized costs of care. Methods We analyzed the Optum Research Database of administrative claims from years 2007 to 2016 representing commercially insured and Medicare Advantage insured IBD patients in the United States. Inflammatory bowel disease patients with and without an MHD were compared in terms of demographics (age, gender, race), insurance type, IBD-related medical utilization (ambulatory visits, emergency department [ED] visits, and inpatient hospitalizations), and total IBD-related costs. Only patients with costs >$0 in each of the utilization categories were included in the cost estimates. Results Of the total IBD study cohort of 52,782 patients representing 179,314 person-years of data, 22,483 (42.6%) patients had at least 1 MHD coded in their claims data with a total of 46,510 person-years in which a patient had a coded MHD. The most commonly coded diagnostic categories were depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Compared with patients without an MHD, a significantly greater percentage of IBD patients with MHDs were female (61.59% vs 48.63%), older than 75 years of age (9.59% vs 6.32%), white (73.80% vs 70.17%), and significantly less likely to be younger than 25 years of age (9.18% vs 11.39%) compared with those without mental illness (P < 0.001). Patients with MHDs had significantly more ED visits (14.34% vs 7.62%, P < 0.001) and inpatient stays (19.65% vs 8.63%, P < 0.001) compared with those without an MHD. Concomitantly, patients with MHDs had significantly higher ED costs ($970 vs $754, P < 0.001) and inpatient costs ($39,205 vs $29,550, P < 0.001) compared with IBD patients without MHDs. Patients with MHDs also had significantly higher total annual IBD-related surgical costs ($55,693 vs $40,486, P < 0.001) and nonsurgical costs (medical and pharmacy) ($17,220 vs $11,073, P < 0.001), and paid a larger portion of the total out-of-pocket cost for IBD services ($1017 vs $905, P < 0.001). Conclusion Patients whose claims data contained both IBD-related and MHD-related diagnoses generated significantly higher costs compared with IBD patients without an MHD diagnosis. Based on these data, we speculate that health care costs might be reduced and the course of patients IBD might be improved if the IBD-treating provider recognized this link and implemented effective behavioral health screening and intervention as soon as an MHD was suspected during management of IBD patients. Studies investigating best screening and intervention strategies for MHDs are needed.

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Inflammatory Bowel Disease Patients’ Perspectives during COVID-19 Pandemic: Results from a Portuguese Survey

GE Portuguese Journal of Gastroenterology ◽

10.1159/000518945 ◽

2021 ◽

pp. 1-9

Author(s):

Joana Branco Revés ◽

Catarina Frias-Gomes ◽

Bárbara Morão ◽

Catarina Nascimento ◽

Carolina Palmela ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Immunosuppressive Therapy ◽

Bowel Disease ◽

Severe Disease ◽

Professional Life ◽

Professional Activity ◽

Biologic Treatment ◽

Increased Risk ◽

Inflammatory Bowel ◽

The Impact

Introduction: Patients with inflammatory bowel disease (IBD) do not seem to be at increased risk of infection by SARS-CoV-2, but there is a concern whether immunosuppressive therapy may be associated with more severe disease. Several clinical practice recommendations have been published to help guide IBD care during the COVID-19 pandemic. Nonetheless, few studies have addressed patients’ perspectives and fears. We aimed to evaluate Portuguese IBD patients’ perspectives on the clinical management of their disease during the SARS-CoV-2 pandemic as well as the impact on their professional life. Methods: An anonymous electronic survey was created using REDCap and was distributed by the Portuguese Association of Inflammatory Bowel Disease (APDI) between May and August 2020. Patients’ perspectives on immunosuppressive therapy, disease management, interaction with gastroenterology departments, and the impact of the pandemic in their professional life were assessed. Patients’ proposals to improve medical care were also evaluated. Descriptive analysis and logistic regression were performed. Results: A total of 137 participants answered the survey (79.6% females, mean age 41.7 ± 12.1 years). Although having IBD and receiving treatment with immunosuppressors (thiopurines, steroids, or biologics) were considered promotors of anxiety, most patients (85.4%) agreed that disease remission was a priority and only a minority of patients interrupted their treatment during the pandemic. In multivariate analysis, active disease, biologic treatment, and use of corticosteroids in the last 3 months were perceived by the patients as high-risk features for increased risk of SARS-Cov-2 infection and more severe disease. Fifty-nine patients (44%) believed that their follow-up was influenced by the pandemic and only 58.8% felt that they had the opportunity to discuss their therapeutic options with their doctor. Sixty-three patients (46.0%) were working from home during the pandemic, although this decision was related to IBD and immunosuppressive therapy in only 36.5 and 39.7% of the cases, respectively. Areas where care could have been improved during the pandemic were identified by patients, namely enhancement of the communication with IBD professionals, conciliation of telemedicine with face-to-face appointments, and facilitation of the interaction between patients and employers. Conclusion: Most patients agreed that maintaining IBD remission is crucial, and only a minority of the patients stopped their treatment as per their own initiative. IBD status only had a small influence on patients’ professional activity during the COVID-19 outbreak, with most changes being related to the pandemic itself.

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P161 The impact of biologic therapies on Extra-Intestinal Manifestations in Inflammatory Bowel Disease: a multicentre observational study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.288 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S239-S240

Author(s):

F Ferretti ◽

M C Monico ◽

R Cannatelli ◽

M V Lenti ◽

A Di Sabatino ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Cumulative Incidence ◽

Adjunctive Therapy ◽

Biologic Therapy ◽

Biologic Agents ◽

Biologic Treatment ◽

Inflammatory Bowel ◽

The Impact ◽

New Onset

Abstract Background A high proportion of Inflammatory Bowel Disease (IBD) patients will develop extraintestinal manifestations (EIMs). Choosing the most appropriate therapeutic strategy among currently available biologics for each patient may often be challenging. Data regarding the effects of gut-selective therapies such as vedolizumab (VDZ) on new-onset and pre-existing EIMs are scarce and often discordant. The main aims of this study were to assess the cumulative incidence of new-onset EIMs and the course of pre-existing EIMs in a large cohort of IBD patients treated with VDZ compared to non-gut selective biologic agents. Methods This multicenter retrospective study collected data of IBD patients on biologic therapy in clinical follow-up at 6 tertiary referral IBD units in Lombardy. Clinical and demographic data of IBD patients were collected. We calculated the cumulative incidence of new-onset EIMs since the introduction of the ongoing biologic therapy, comparing patients on VDZ with patients on non-gut selective therapies. Furthermore, we analyzed the course of pre-existing and new-onset EIMs in these two cohorts of patients. Results Data about 973 IBD patients (624 CD, 339 UC, 10 IBD-U; median age 46 years; 59% males) on biologic therapy were collected. Of them, 215 were on VDZ and 758 were on non-gut-selective agents, with a median treatment duration with the ongoing therapy of 3 years. The overall prevalence of EIMs in this IBD cohort of patients was 19.8% (193/973 patients). The overall cumulative incidence of new-onset EIMs was of 4.1 % (40/973): 13 on VDZ (13/215) versus 27 (27/758) in the non-gut selective group (6% vs 3.6%, p = 0.1). Regardless of the type of biologic agents, the female sex and the duration of the ongoing biologic treatment were statistically associated with a higher risk of developing EIMs. About 17% of IBD patients reported a pre-existing EIM. Compared to non-gut selective therapies, patients on VDZ showed a significantly higher rate of worsening or absence of response (8.1% vs 19.4%, 12/148 vs 7/36, p=0.04). However, in both groups, a modification of the therapeutic protocol has been necessary with the introduction of adjunctive therapy, the switch, or the optimisation of the ongoing biologic therapy (27.8% patients on VDZ versus 25% on non-gut selective therapies, p=0.7). Conclusion Our study suggests that the type of biologic treatment does not affect the risk of new-onset of EIMs. However, in the case of pre-existing EIMs, a subtle higher risk of worsening can be speculated after starting VDZ, even if the proportion of patients who will need adjunctive therapy, the optimisation or switch of the ongoing treatment would be similar between gut-selective and non-gut selective therapies.

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Why is there Low utilization of Biosimilars in Inflammatory Bowel Disease Patients by Gastroenterology Advanced Practice Providers?

Crohn's & Colitis 360 ◽

10.1093/crocol/otab004 ◽

2021 ◽

Author(s):

Nana Bernasko ◽

Kofi Clarke

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Care ◽

The United States ◽

Advanced Practice ◽

Medical Specialties ◽

Healthcare Settings ◽

The Usa ◽

Knowledge Practice ◽

Inflammatory Bowel

Abstract Aim To assess knowledge, practice patterns and attitudes towards the use of biosimilars by Advanced Practice Providers (APPs) treating patients with Inflammatory Bowel Disease (IBD). Background APPs provide care in a variety of healthcare settings including medical specialties. In Gastroenterology, they are an integral part of providing care to a complex group of patients with IBD. There has been an increase in options of medical therapies for treating IBD. These include small molecules, biologics and biosimilars. Adoption of biosimilars for treatment of IBD patients by gastroenterologists in the USA compared to Europe has been slow for several reasons. There is lack of data on their use by Advanced Practice Providers who provide frontline IBD clinical care in the United States. Methods Questionnaire based survey of APPs attending Gastroenterology conferences with a focus on IBD. Results Advanced Practice Providers in gastroenterology do not routinely consider the use of biosimilars in their practice. Conclusion There is low utilization of biosimilars in treating IBD patients by APPs. In addition, there are significant concerns about risk of side effects as well as perceived lack of APP targeted educational resources.

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N27 What people want! Exploring inflammatory bowel disease patients’ perspectives on healthcare professionals addressing sexual well-being

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.1010 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S669-S670

Author(s):

S Fourie ◽

W Czuber-Dochan ◽

C Norton

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Healthcare Professionals ◽

Clinical Care ◽

Holistic Approach ◽

Well Being ◽

Structured Interviews ◽

Time Space ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Inflammatory bowel disease (IBD) affects every aspect of one’s life, yet no routine assessment for the impact on sexuality is made. Our aim was to explore patients’ perspective on healthcare professionals (HCPs) addressing sexuality/sexual well-being concerns. Methods This was a qualitative narrative study. Inclusion criteria were any sexual orientation and with known IBD for longer than 18 months. Data were collected via semi structured interviews and anonymous narrative accounts submitted via Google Forms. Thematic analysis was used to analyse the data. Results Fourteen adults, 4 male and 10 female, took part. Eleven participants were from the UK, one from the USA of America and one for South Africa. The following main themes and subthemes were identified: I cannot imagine talking about my sex life (a difficult topic; there is not enough time), Those who talked about sex, talked badly (nobody volunteered information; badly handled conversations), Still living whilst unwell (sex is an important part of my life; sex issues break down relationships, medicalised body), IBD ruined my sex life (feeling unattractive; feelings of shame and embarrassment), I feel unheard (HCPs don’t open the discussion; sex not taken seriously), I’m a person, not my IBD (holistic approach to care; time, space and ways to talk about sex). The findings reflect the importance of sexual well-being to those living with IBD, the experiences of such conversations, barriers to conversations with HCPs on sexual well-being, and suggestions on how HCPs should address their unmet needs. The importance of discussing intimacy and sexuality was emphasised, as participants felt their sexual well-being was considerably affected by IBD. The majority reported that HCPs did not initiate discussions on sexual well-being, nor did they understand the impact of IBD on sexual well-being, with a distinct accent on the perceived lack of a holistic approach to their care. Therefore, participants made suggestions for practice, such as provision of information related to sexual well-being in the form of leaflets, additionally to HCPs raising the issue. Conclusion Our findings indicate that communicating on sexuality/sexual well-being is a problematic area of IBD care. HCPs must be cognisant of the sexual well-being concerns and needs of those living with IBD, who want this topic discussed routinely, as part of a holistic approach to their clinical care.

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A173 INNOVATIVE CARE FOR INFLAMMATORY BOWEL DISEASE PATIENTS DURING THE COVID-19 PANDEMIC: USE OF BEDSIDE INTESTINAL ULTRASOUND TO OPTIMIZE MANAGEMENT

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.171 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 184-185

Author(s):

K L Novak ◽

C Ma ◽

H Kheirkhahrahimabadi ◽

j heatherington ◽

R Ingram ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Acute Care ◽

Bowel Disease ◽

Care Pathway ◽

Clinical Care ◽

Tertiary Care ◽

Care Utilization ◽

Non Invasive ◽

Inflammatory Bowel ◽

The Impact

Abstract Background The COVID-19 pandemic has led to significant alterations in the ability to deliver outpatient care to patients with inflammatory bowel disease (IBD) including endoscopic evaluation. This has highlighted the need for alternative, accurate, non-invasive strategies to safely assess disease activity. Aims The aim of this study is to describe the impact of point of care intestinal ultrasound (IUS) in a university-based tertiary care IBD urgent access clinic. Methods We prospectively evaluated a comprehensive care pathway which incorporated outpatient sigmoidoscopy and intestinal ultrasound with the purpose of directing further ambulatory clinical care and avoiding hospitalization or hospital-based investigations including endoscopy during the COVID pandemic for patients with established IBD with symptoms suggestive of a disease flare, or those at high risk of a new diagnosis of IBD. Non-invasive markers C Reactive Protein (CRP) and fecal calprotectin (fCal) were collected where available. Patients were pre-screened for influenza-like illness, as COVID-19 testing was not available for this population during the study period. Substantial management changes were defined as addition of any medications, biologic switch/ optimization, and or referral for surgical consultation. Results Between March 15th and June 30th 2020, a total of 72 patients were seen in the urgent access clinic. All patients were seen within 7 days of referral. The majority were female 57% (41/72) and/ or had Crohn’s disease 65.5% (47/72) (Table 1). Of these, 84.7% (61/72) underwent a substantial management change based on features of active inflammation detected by either IUS alone (53% 38/72) sigmoidoscopy alone (12.5% 9/72) or combination IUS with in-clinic sigmoidoscopy (32% 23/72) in addition to CRP and fCal. Three new diagnoses of IBD were made: one colonic Crohn’s and 2 with ulcerative colitis. One pregnant patient avoided all acute care utilization. Five patients were referred to colorectal surgery for urgent resection including two patients admitted directly for emergent operations. No patients required visits to the emergency department. Furthermore, there have been no unscheduled hospitalizations occurred in this cohort since inception March 23, 2020 til November 15th 2020. Conclusions The implementation of IUS in a centralized, urgent access clinic pathway resulted in efficient and meaningful changes in IBD management while sparing the need for acute care services including ER visits, need for in-hospital endoscopy, and hospitalization. The pandemic highlights the utility of this patient-center tool and supports expansion of wider IUS adoption. Funding Agencies None

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Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

10.7287/peerj.preprints.476v1 ◽

2014 ◽

Author(s):

Michelle Park ◽

Jay Bhattacharya ◽

KT Park

Keyword(s):

Inflammatory Bowel Disease ◽

Low Income ◽

Bowel Disease ◽

Clinical Care ◽

The United States ◽

Medical Expenditure ◽

Insurance Status ◽

Inflammatory Bowel ◽

Publicly Insured ◽

Insured Patients

Background: Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD). Aim: To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US). Methods: We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn’s disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures. Results: Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N=238), $7,827 (N=95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N=276,372, p<0.05). Publicly insured patients incurred the highest costs ($18,067), over privately insured ($8,014, p<0.05) or uninsured patients ($5,129, p<0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p<0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI 1.08-4.19) or no insurance (OR 4.94, CI 1.26-19.47), with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI 0.15-0.95) and office-based care (OR 0.21, CI 0.07-0.62). Conclusions: In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.

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Persistence with Biologic Treatment in Patients with Inflammatory Bowel Disease: A German Claims Data Analysis

Digestion ◽

10.1159/000503859 ◽

2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Antje Mevius ◽

Alina Brandes ◽

Fränce Hardtstock ◽

Thomas Wilke ◽

Boris A. Ratsch ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Data Analysis ◽

Bowel Disease ◽

Claims Data ◽

Biologic Treatment ◽

Inflammatory Bowel ◽

Claims Data Analysis

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Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

10.7287/peerj.preprints.476 ◽

2014 ◽

Author(s):

Michelle Park ◽

Jay Bhattacharya ◽

KT Park

Keyword(s):

Inflammatory Bowel Disease ◽

Low Income ◽

Bowel Disease ◽

Clinical Care ◽

The United States ◽

Medical Expenditure ◽

Insurance Status ◽

Inflammatory Bowel ◽

Publicly Insured ◽

Insured Patients

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Impact of the World Inflammatory Bowel Disease Day and Crohn’s and Colitis Awareness Week on Population Interest Between 2016 and 2020: Google Trends Analysis

JMIR Infodemiology ◽

10.2196/32856 ◽

2021 ◽

Vol 1 (1) ◽

pp. e32856

Author(s):

Krixie Silangcruz ◽

Yoshito Nishimura ◽

Torrey Czech ◽

Nobuhiko Kimura ◽

Hideharu Hagiya ◽

...

Keyword(s):

United States ◽

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Public Awareness ◽

The United States ◽

The Public ◽

The World ◽

Inflammatory Bowel ◽

The Impact

Background More than 6 million people are affected by inflammatory bowel disease (IBD) globally. The World IBD Day (WID, May 19) and Crohn’s and Colitis Awareness Week (CCAW, December 1-7) occur yearly as national health observances to raise public awareness of IBD, but their effects are unclear. Objective The aim of this study was to analyze the relationship between WID or CCAW and the public health awareness on IBD represented by the Google search engine query data. Methods This study evaluates the impact of WID and CCAW on the public awareness of IBD in the United States and worldwide from 2016 to 2020 by using the relative search volume of “IBD,” “ulcerative colitis,” and “Crohn’s disease” in Google Trends. To identify significant time points of trend changes (joinpoints), we performed joinpoint regression analysis. Results No joinpoints were noted around the time of WID or CCAW during the study period in the search results of the United States. Worldwide, joinpoints were noted around WID in 2020 with the search for “IBD” and around CCAW in 2017 and 2019 with the search for “ulcerative colitis.” However, the extents of trend changes were modest without statistically significant increases. Conclusions These results posed a question that WID and CCAW might not have worked as expected to raise public awareness of IBD. Additional studies are needed to precisely estimate the impact of health observances to raise the awareness of IBD.

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