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  • Scott Adams
    Scott Adams

    IBD Can Require More Intense Management and Drive up Treatment Costs

    Reviewed and edited by a celiac disease expert.

    IBD patients less predictable, and may may require more intense care, due to higher cost volatility.

    IBD Can Require More Intense Management and Drive up Treatment Costs - Stock exchange. Image: CC BY 2.0-- rednuht
    Caption: Stock exchange. Image: CC BY 2.0-- rednuht

    Celiac.com 06/01/2020 - People with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis (UC) can have difficulty determining when their symptoms are worsening, which can make them prone to more complications and hospitalizations, according to Lawrence Kosinski, MD, founder and chief medical officer of SonarMD.

    That can mean highly variable per patient costs, higher overall costs, and more intense patient management, according to data from DDW. Kosinski and colleagues suggest that profiling chronic gastrointestinal diseases by gauging volatility based on cost might offer a hedge against this volatility, in much the same was as it does on the stock market. 



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    “Like stocks in the stock market, diseases can be profiled by their volatility...Variability drives cost for these diseases...Some diseases have high variability (high beta), whereas others have low variability (low beta)...The higher the variability (beta rating), the higher the overall cost/patient,” says Kosinski.

    To calculate an index and beta rating for chronic gastrointestinal diseases, the researchers used data from nearly 41,000 members of the Health Care Service Corporation, such as professional, facility and pharmacy claims for calendar year 2017. From that data, they were able to calculate an index and beta rating for GERD, peptic ulcer disease (PUD), gastritis, celiac disease, pancreatitis, irritable bowel syndrome, Crohn’s disease, UC, colon polyps and diverticulitis.

    They began by calculating the total disease specific cost for each condition, and used it to build a GI Disease Index with the total disease specific cost for each GI condition, which they separated into deciles. When they determined the cost per decile for each condition, and compared that with the GI index, they found strongly positive beta scores in celiac disease and UC, but in no other GI conditions.

    The team notes that less variable conditions have more predicable costs and outcomes, and so may be better suited for bundled payments and more episodic care. According to Kosinski, value-based programs with a focus on care coordination, patient engagement and disease management, can improve care and lower costs, high beta conditions.

    The team is encouraging insurers and gastroenterologists "to work together to engage patients with high beta conditions, track symptoms, catch deterioration early, and intervene before it becomes a bigger problem,” he said. The result could be healthier patients and better bottom lines for everyone.

    Stay tuned for more on this and related stories.

    Read more at Healio.com



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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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  • Related Articles

    Jefferson Adams
    Celiac.com 06/04/2015 - Some researchers feel that people who self report non-celiac gluten sensitivity (SR-NCGS) and also follow a gluten-free diet might actually fall within the spectrum of irritable bowel (IBS). Interestingly, recent reports suggest that large numbers of people with inflammatory bowel disease (IBD) also follow a gluten-free diet.
    A research team recently assessed the relationship between IBD and self-reported non-celiac gluten sensitivity (SR-NCGS). The team included I.Aziz, F. Branchi, K. Pearson, J. Priest, and D.S. Sanders. They are variously affiliated with the Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom; and the Gastroenterology and Endoscopy Unit in the Department of Pathophysiology and Transplantation at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplant, Università degli Studi di Milano in Milan, Italy.
    To screen for SR-NCGS and the use of a GFD, they used a cross-sectional questionnaire in 4 groups: ulcerative colitis (n = 75), Crohn's disease (n = 70), IBS (n = 59), and dyspeptic controls (n = 109). They also looked at diagnostic outcomes for IBD in 200 patients presenting with SR-NCGS.
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    For the purposes of of this study, the team made no differences between ulcerative colitis and Crohn's disease. However, 40.9% of Crohn's disease patients with SR-NCGS suffered from stricturing disease, compared with 18.9% for Chrohn's patients without SR-NCGS; (P = 0.046). Crohn's disease patients with SR-NCGS showed higher overall scores on the Crohn's Disease Activity Index (228.1 versus 133.3, P = 0.002) than those without SR-NCGS.
    The team analyzed 200 cases presenting with SR-NCGS, and found that 197 of them, or 98.5% were most likely diet-related IBS. However, 3 of the SR-NCGS patients (1.5%) actually had IBD, with all of the associated alarm symptoms, and/or abnormal blood parameters.
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    Source:
    Inflamm Bowel Dis. 2015 Apr;21(4):847-53. doi: 10.1097/MIB.0000000000000335.


    Jefferson Adams
    Celiac.com 12/28/2018 - Beyond a few teaser studies, we don’t know enough about whether the individual micro-biome might play a role in the development of celiac disease and inflammatory bowel disease.
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    The article includes a paywall, but you may find it at:
    Adv Exp Med Biol. 2018 Dec 20. doi: 10.1007/5584_2018_317


    Scott Adams
    Celiac.com 04/30/2020 - Patients with inflammatory bowel disease (IBD) seem to suffer milder effects in the disease phase of COVID-19 than other patients, according to two new reports. That may be due to their treatment with immunosuppressant drugs, including salicylates. What's going on? Could people with celiac disease share a similar benefit?
    Because many patients with IBD receive immunosuppressive drugs, doctors have wondered whether those patients might be more susceptible to COVID-19, or its effects. On the other hand, immunomodulatory therapies might also suppress the hyperinflammatory cytokine response associated with the most severe presentations of COVID-19.
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    During the observation period, the team saw no cases of COVID-19 in this group, and none of the 522 IBD patients were hospitalized with SARS-CoV-2 infection. However, during the same period, 479 patients with no IBD history were hospitalized for severe COVID-19 and respiratory failure.
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    Read more in Gastroenterology and bmj.com
     


    Scott Adams
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    Certainly, the idea that IBD and celiac disease may be connected in some way does not seem far fetched. Stay tuned for more on this and other issues.
    Read more at gastrojournal.org


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