Date of Award
2019
Embargo Period
1-1-2019
Document Type
Dissertation
Degree Name
Doctor of Health Administration
College
College of Health Professions
First Advisor
Annie Simpson
Second Advisor
Daniel Brinton
Third Advisor
Annie Andrews
Abstract
Background: Biologic agents that block tumor necrosis factor-α (anti-TNF) have been FDA approved for treatment of Inflammatory Bowel Disease, Crohn’s disease and Ulcerative Colitis, in both adults and children, they have better efficacy when started early in disease course but access can be limited due to cost. The objective of this study is to address whether the current differential drug coverage methods between privately and publicly insured children is associated with timely access to biologics and differences in healthcare utilization using pediatric Crohn’s disease as a model. Methods: Children with a diagnosis of Crohn’s disease were identified from Truven Health MarketScan Commercial and Medicaid databases using ICD-9/ICD-10 codes. Patients were classified by payer type into 2 categories: Public/Medicaid fee-for-service, or as Commercial/Privately Insured. Time from diagnosis (as determined by date of endoscopy) to biologic and utilization data was established and compared between groups. Results: We identified 6163 patients with a diagnosis of CD. Mean age was 14.8 years (SD2.7), 10% had Medicaid FFS and 89% had private insurance. There were no significant differences in each payer group’s demographic characteristics or comorbidities. Over the 18-month follow-up period, a significantly higher proportion of Medicaid patients received a biologic agent within 18 months of diagnosis compared to privately insured children [132 (20.4%) in Medicaid and 851 (15.4%) private insurance (p value=.0004)]. Rates of hospitalizations and ED visits were significantly higher for the Medicaid group in both pre- and post-index dates. Discussion: In this nationally representative sample of children with Crohn’s Disease, children with Medicaid were more likely to receive a biologic within 18 months of diagnosis compared to children with private insurance. They utilized emergency room services and required hospitalization at a significantly higher rate and this highlights care management issues that need to be addressed going forward to lower cost of care in pediatric Crohn’s disease.
Recommended Citation
Quiros, J. Antonio, "Tackling Specialty Drug Access and Cost of Care in Our Modern Age: Using Pediatric Crohn’s Disease Care as a Model" (2019). MUSC Theses and Dissertations. 228.
https://medica-musc.researchcommons.org/theses/228
Rights
All rights reserved. Copyright is held by the author.