Direct hospital costs for patients with inflammatory bowel disease in a Canadian tertiary care university hospital

OBJECTIVE: We set out to determine the direct costs of hospitalizations of patients with Crohn's disease and ulcerative colitis admitted to a universi ty-affiliate tertiary care hospital and to contrast the costs of medical ve rsus surgical inpatient care, Crohn's disease versus ulcerative colitis, an d to identify dominant components of inpatient costs. METHODS: We used a patient-specific case costing system at Saint Boniface G eneral Hospital, Winnipeg, Manitoba, for fiscal years 1994 and 1995. We ext racted all inpatients whose hospital discharge abstracts included ICD-9-CM codes 555 (Crohn's disease) and 556 (ulcerative colitis) among the top eigh t discharge diagnoses, and performed a chart review on all cases to ensure that the hospitalization was for inflammatory bowel disease and the diagnos es were accurate. We analyzed cases based on their disease diagnosis, prima ry mode of therapy associated with the hospitalization (medical vs surgical ), and their major diagnosis-related group (DRG). This study evaluated dire ct patient care costs only and costs are expressed in Canadian dollars. RESULTS: Of 362 hospital admissions, 325 were eligible and of these admissi ons 275 belonged to the digestive system DRGs. Seventy-one (37%) were admit ted more than once during the 2 yr of the study, accounting for 202 (62%) o f the total number of admissions. The mean cost per admission of all cases of Crohn's disease was $3,149 (95% confidence interval [CI], $2,665-$3,634) and for ulcerative colitis was $3,726 (95% CI $3,008-$4,445). Surgical the rapy cases accounted for 49.8% of all admissions, 57.8% of all hospital day s, and 60.5% of all costs. Patients treated surgically had more costly hosp italizations than those treated medically, particularly when analyzing only nontotal parenteral nutrition (TPN) cases. Surgical treatment admissions w ere significantly more costly for ulcerative colitis digestive DRG admissio ns than Crohn's disease. The nondigestive DRG admissions were more costly t han the digestive DRGs in all categories although this was only statistical ly different among medically treated Crohn's disease. Patients treated medi cally were similarly costly whether they had Crohn's disease or ulcerative colitis. There was no significant difference in cost per admission among ca ses admitted multiple times, compared with those admitted only once. TPN ca ses accounted for 9.5% of cases but 27.1% of costs. TPN-associated hospital izations were more costly than non-TPN-use hospitalizations but these costs were primarily driven by duration of stay rather than TPN use itself. For all cases, the top five cost categories in descending order were nursing un it bed-days, drugs and pharmacy, diagnostic lab tests, operating room, and diagnostic imaging and endoscopy. CONCLUSIONS: Using our system we could determine direct costs for inpatient s with inflammatory bowel disease and the factors that determined increased costs. Medical therapy admissions were similarly costly between Crohn's di sease and ulcerative colitis; however, surgical therapy admissions were cos tlier among ulcerative colitis patients. Admissions for nondigestive DRGs w ere more costly than those for digestive DRGs. TPN use identified a sicker group of patients who remained in the hospital longer than nonusers and, no t surprisingly, these were the costliest patients. (Am J Gastroenterol 2000 ;95:677-683. (C) 2000 by Am. Coll. of Gastroenterology).