Abstract：
BACKGROUND: The incidence of pediatric-onset inflammatory bowel disease (IBD) and the costs of caring for individuals with IBD are both increasing. We calculated the direct healthcare costs of pediatric IBD in the first year after diagnosis and developed a model to predict children who would have high costs (top 25th percentile).
METHODS: Using data from the Canadian Children IBD Network inception cohort (≤16 years of age, diagnosed between 2013 and 2019) deterministically linked to health administrative data from Ontario, Canada, we estimated direct healthcare and medication costs accrued between 31 and 365 days after diagnosis. Candidate predictors included age at diagnosis, sex, rural/urban residence location, distance to pediatric center, neighborhood income quintile, IBD type, initial therapy, disease activity, diagnostic delay, health services utilization or surgery around diagnosis, regular primary care provider, and receipt of mental health care. Logistic regression with stepwise elimination was used for model building; 5-fold nested cross-validation optimized and improved model accuracy while limiting overfitting.
RESULTS: The mean cost among 487 children with IBD was CA$15 168 ± 15 305. Initial treatment (anti-tumor necrosis factor therapy, aminosalicylates, or systemic steroids), having a mental health care encounter, undergoing surgery, emergency department visit at diagnosis, sex, and age were predictors of increased costs, while having a regular primary care provider was a predictor of decreased costs. The C-statistic for our model was 0.71.
CONCLUSIONS: The cost of caring for children with IBD in the first year after diagnosis is immense and can be predicted based on characteristics at diagnosis. Efforts that mitigate rising costs without compromising quality of care are needed.
Cost of caring for children with IBD is high—CA$15 168 between 31 and 365 days from diagnosis in 487 Canadian children. Predictors of high costs included anti-tumor necrosis factor therapy and mental health care, with lower costs in those with a primary-care provider.
METHODS: Using data from the Canadian Children IBD Network inception cohort (≤16 years of age, diagnosed between 2013 and 2019) deterministically linked to health administrative data from Ontario, Canada, we estimated direct healthcare and medication costs accrued between 31 and 365 days after diagnosis. Candidate predictors included age at diagnosis, sex, rural/urban residence location, distance to pediatric center, neighborhood income quintile, IBD type, initial therapy, disease activity, diagnostic delay, health services utilization or surgery around diagnosis, regular primary care provider, and receipt of mental health care. Logistic regression with stepwise elimination was used for model building; 5-fold nested cross-validation optimized and improved model accuracy while limiting overfitting.
RESULTS: The mean cost among 487 children with IBD was CA$15 168 ± 15 305. Initial treatment (anti-tumor necrosis factor therapy, aminosalicylates, or systemic steroids), having a mental health care encounter, undergoing surgery, emergency department visit at diagnosis, sex, and age were predictors of increased costs, while having a regular primary care provider was a predictor of decreased costs. The C-statistic for our model was 0.71.
CONCLUSIONS: The cost of caring for children with IBD in the first year after diagnosis is immense and can be predicted based on characteristics at diagnosis. Efforts that mitigate rising costs without compromising quality of care are needed.
Cost of caring for children with IBD is high—CA$15 168 between 31 and 365 days from diagnosis in 487 Canadian children. Predictors of high costs included anti-tumor necrosis factor therapy and mental health care, with lower costs in those with a primary-care provider.
摘要：
背景：儿科发病的炎症性肠病（IBD）的发病率和照顾IBD患者的费用都在增加。我们计算了诊断后第一年小儿IBD的直接医疗费用，并开发了一个模型来预测儿童的高费用（前25个百分位数）。
方法：使用来自加拿大儿童IBD网络初始队列的数据（≤16岁，在2013年至2019年之间诊断)与安大略省的卫生行政数据有确定性联系，加拿大,我们估计诊断后31~365天的直接医疗和药物费用.候选预测因子包括诊断时的年龄，性别,农村/城市居住地，距离儿科中心，邻里收入五分之一，IBD类型,初始治疗,疾病活动,诊断延迟,医疗服务利用或诊断周围的手术，正规的初级保健提供者，和接受精神卫生保健。逐步消除的Logistic回归用于模型构建；5倍嵌套交叉验证优化并提高了模型准确性，同时限制了过拟合。
结果：487名IBD儿童的平均费用为15168±15305加元。初始治疗（抗肿瘤坏死因子治疗，氨基水杨酸盐,或全身性类固醇），有一次精神健康护理，正在接受手术,诊断时急诊就诊，性别,年龄是成本增加的预测因素，而拥有正规的初级保健提供者是成本下降的预测因素.我们模型的C统计量为0.71。
结论：在诊断后的第一年照顾IBD儿童的费用是巨大的，可以根据诊断时的特征进行预测。需要努力在不损害护理质量的情况下减轻不断上升的成本。
照顾IBD儿童的费用很高-在487名加拿大儿童诊断后31至365天之间，CA$15168。高成本的预测因素包括抗肿瘤坏死因子治疗和精神保健，那些有初级保健提供者的人的成本更低。
方法：使用来自加拿大儿童IBD网络初始队列的数据（≤16岁，在2013年至2019年之间诊断)与安大略省的卫生行政数据有确定性联系，加拿大,我们估计诊断后31~365天的直接医疗和药物费用.候选预测因子包括诊断时的年龄，性别,农村/城市居住地，距离儿科中心，邻里收入五分之一，IBD类型,初始治疗,疾病活动,诊断延迟,医疗服务利用或诊断周围的手术，正规的初级保健提供者，和接受精神卫生保健。逐步消除的Logistic回归用于模型构建；5倍嵌套交叉验证优化并提高了模型准确性，同时限制了过拟合。
结果：487名IBD儿童的平均费用为15168±15305加元。初始治疗（抗肿瘤坏死因子治疗，氨基水杨酸盐,或全身性类固醇），有一次精神健康护理，正在接受手术,诊断时急诊就诊，性别,年龄是成本增加的预测因素，而拥有正规的初级保健提供者是成本下降的预测因素.我们模型的C统计量为0.71。
结论：在诊断后的第一年照顾IBD儿童的费用是巨大的，可以根据诊断时的特征进行预测。需要努力在不损害护理质量的情况下减轻不断上升的成本。
照顾IBD儿童的费用很高-在487名加拿大儿童诊断后31至365天之间，CA$15168。高成本的预测因素包括抗肿瘤坏死因子治疗和精神保健，那些有初级保健提供者的人的成本更低。
