C0394 - Evaluation of Quality-of-Care Indicators Among Patients With Crohn’s Disease and Ulcerative Colitis in the United States: 2019–2020

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

JC

J Casey Chapman, MD

GI Alliance; Crohn's and Colitis Center at the Baton Rouge General; Louisiana State University Health Sciences Center
Baton Rouge, LA

J Casey Chapman, MD¹, Dolly Sharma, PhD², Jenny Griffith, ², Cindy Theigs, RPH², Siran Fang, ²
¹GI Alliance; Crohn's and Colitis Center at the Baton Rouge General; Louisiana State University Health Sciences Center, Baton Rouge, LA; ²AbbVie, Inc., North Chicago, IL

Introduction: Crohn’s disease (CD) and ulcerative colitis (UC) can be difficult to manage and, due to a lack of meaningful quality measures, patient (pt) care may vary by provider. To understand where gaps in care may exist for these pts, this study assessed specific healthcare resource utilization (HRU) and medication metrics that may be potential quality of care (QOC) indicators.

Methods: Using a large commercial US claims database (2019–2020), pts with CD or UC were identified. Potential QOC indicators were selected based on clinical guidelines and recommendations from measures of quality organizations and included CD or UC prevalence; gastroenterologist (GE) and IBD-related non-GE outpatient visits; IBD-related emergency department visits or hospitalizations; excessive steroid use (prednisone equivalent ≥10 mg/day for ≥60 consecutive days or a single prescription of ≥600 mg prednisone); excessive steroid users on corticosteroid (CS)-sparing therapy; excessive steroid users with central dual-energy X-ray absorptiometry (DEXA) or osteoporosis pharmacologic treatment; use of targeted immunomodulators (TIMs) and oral mesalamine (CD only); imaging assessments; and assessment of inflammatory biomarkers. National percentages of pts achieving each metric are reported.

Results: In total, 41,555 CD and 52,507 UC pts were identified in 2019, resulting in a 0.3% and 0.4% prevalence, respectively (Table). Over a third of CD pts (39.8%) and almost half of UC pts (45.5%) did not visit a GE in 2019. Around 10% CD pts, and up to 6.4% of UC pts, had IBD-related ED visits or hospitalizations. 17.1% CD and 14.5% UC pts were excessive steroid users, yet < 9% CD and UC pts, received DEXA scans and/or bone treatments. A third of excessive steroid users with CD (34.5%), and over half (53.0%) of those with UC, did not receive CS-sparing therapy. The rate of TIM use was over two times higher in CD vs UC pts (CD: 44.3%; UC: 18.9%). Despite evidence that mesalamine is ineffective in CD, 18.7% of pts with CD were prescribed it. Inflammatory biomarker level testing rates were < 50% in both CD and UC. Similar outcomes were reported in 2020, with lower HRU, possibly due to COVID-19.

Discussion: This analysis of QOC indicators highlights various areas for improvement that may provide better treatment outcomes and reduce HRU for pts with CD and UC. Future research is needed to assess outcomes in pts that are not being routinely monitored.

Table 1: Proportion of CD and UC patients achieving potential QOC metrics by year

Indicator	2019		2020
Indicator	CD N=41,555^a	UC N=52,507^a	CD N=39,025^a	UC N=47,940^a
Diagnosis Rate	0.3%	0.4%	0.3%	0.4%
GE Outpatient Visits	60.2%	54.5%	57.5%	52.9%
IBD-Related Non-GE Outpatient Visit	38.5%	43.8%	41.3%	45.6%
IBD-related ED Visits	11.2%	4.7%	9.9%	4.5%
IBD-related Hospitalizations	10.3%	6.4%	9.1%	5.9%
Excessive Steroid Use^b Corticosteroid-Sparing Therapy^c,d DEXA or Bone Treatment^c,e,f	17.1% 65.5% 8.9%	14.5% 47.0% 7.9%	15.8% 66.9% 8.0%	14.5% 49.4% 6.9%
Targeted Immunomodulator Use	44.3%	18.9%	48.4%	22.2%
Oral Mesalamine^g	18.7%	N/A	17.0%	N/A
Imaging^h	59.4%	64.2%	54.0%	58.0%
Inflammatory Biomarkersⁱ	49.8%	35.8%	49.9%	36.9%

Table: a) Sample size shown is based on continuous eligibility in medical benefit. Denominator for medication use outcomes focused on patients fully enrolled in both medical and pharmacy benefit, and thus were a subset of the larger population. b) Excessive steroid use was defined as doses ≥10 mg/day prednisone equivalent for ≥60 consecutive days or a single prescription of ≥600 mg prednisone. c) In excessive steroid users only. d) Treatments included thiopurine, methotrexate, or TIMs. e) All indicators were within the respective calendar year except DEXA/bone treatments that occurred during the prior calendar year. f) Defined as prescription osteoporosis treatment, excluding vitamin and mineral supplements. g) In patients with CD only. h) Including endoscopy, CT scan, MRI, or ultrasound. i) Including fecal calprotectin and c-reactive protein.

CD, Crohn’s disease; CT, computed tomography; DEXA, dual-energy X-ray absorptiometry; ED, emergency department; GE, gastroenterologist; IBD, inflammatory bowel disease; TIM, targeted immunomodulator; UC, ulcerative colitis

Disclosures:

J Casey Chapman: Abbvie – Consultant, Speakers Bureau. Janssen – Consultant, Speakers Bureau. Pfizer – Consultant, Speakers Bureau. Takeda – Consultant, Speakers Bureau.

Dolly Sharma: AbbVie – Employee, Stock-publicly held company(excluding mutual/index funds).

Jenny Griffith: Abbvie – Employee, Stock-publicly held company(excluding mutual/index funds).

Cindy Theigs: Abbvie – Employee, Stock-publicly held company(excluding mutual/index funds).

Siran Fang: Abbvie – Employee, Stock-publicly held company(excluding mutual/index funds).

J Casey Chapman, MD¹, Dolly Sharma, PhD², Jenny Griffith, ², Cindy Theigs, RPH², Siran Fang, ². C0394 - Evaluation of Quality-of-Care Indicators Among Patients With Crohn’s Disease and Ulcerative Colitis in the United States: 2019–2020, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.