P851 Impact of an integrated model of care for inflammatory bowel disease on direct healthcare costs: A population-based matched cohort study from Saskatchewan, Canada
Notice bibliographique
Résumé
Abstract Background Integrated models of care (IMC) for IBD lead to reduced hospitalizations, surgeries, comorbidities, and overall improved outcomes. There are limited studies assessing the impact of IMC on direct healthcare costs. We aimed to estimate the impact of exposure to an IMC on direct healthcare costs among individuals diagnosed with IBD. Methods We conducted a quasi-experimental difference-in-difference (DID) cost analysis using administrative health data from Saskatchewan, Canada. We included individuals ≥18 years old meeting a validated administrative IBD case definition between January 2009 and March 2015. IBD cases were classified as exposed or non-exposed to the Saskatchewan IMC and required to have three years of healthcare coverage after baseline (i.e., first visit with an IMC [exposed] or a non-IMC [non-exposed] gastroenterologist). The direct healthcare costs were derived from the administrative databases, adjusted to 2014/15 Canadian dollars, and categorized into hospitalizations, physician visits, and medication claim costs (i.e., immunomodulators [IMM], biologics [BIOL], aminosalicylates[5-ASA]). Propensity scores (PS) were calculated based on healthcare utilization and comorbidities in the 12 months before baseline. Cases (exposed) were matched 1:5 controls (non-exposed) based on PS and disease duration. DID estimators were determined for each cost category using mixed linear regression models including age, sex, disease type, and area of residence as covariables. Results In total, 2905 IBD cases were included in the study, 597 exposed and 2308 non-exposed individuals (Figure); the majority were females (52%), lived in urban areas (74%), and had Crohn’s Disease (61%). The mean age was 44.6 years (SD=15.5) and the average disease duration at baseline was 5.7 years (SD=5). In comparison to the non-exposed group, the costs of physician visits (IBD-related [DID= $-139, 95%CI -209 to -68], IBD-specific [DID=$-155, 95%CI -212 to -97], and specialty visits [DID=$-135, 95%CI -201 to -69]); and IMM dispensations (DID=$-18, 95%CI -35 to -2) were lower in the exposed group. Conversely, we identified higher total healthcare costs (DID=$1707, 95%CI 369 to 3044); IBD-related medication (DID=$2341, 95%CI 1484 to 3197) and BIOL (DID= $2467, 95%CI 1605 to 3328) dispensations costs in the exposed group. There were no other statistically significant differences between the groups. Conclusion We identified lower physician visit and IMM costs in the exposed group than in the non-exposed one. Total healthcare costs were higher among the exposed group, largely driven by higher BIOL costs. These results highlight the potential cost impact of IMC for IBD and the need for cost-effectiveness studies of IMC to further assess value of this care model.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,005 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».