UNDERSTANDING THE IMPACT OF COMPLEX CHRONIC DISEASES

BEYOND DIABETES AND HYPERTENSION

PUTTING THE FOCUS ON INFLAMMATORY BOWEL DISEASE

2

WHAT IS INFLAMMATORY BOWEL DISEASE (IBD)?

IBD INCLUDES 2 CHRONIC AUTOIMMUNE DISEASES THAT CAN INVOLVE INFLAMMATION OF ALL OR PART OF THE DIGESTIVE TRACT1

CD AND UC ARE LIFELONG CONDITIONS WITH NO CURE2 Both diseases are associated with:

• Frequent bowel movements3 • Periods of flares and remission• Increase in risk for colorectal cancer2 • Destructive inflammation and serious complications4

Crohn’sdisease (CD)

can a�ect anypart of the

digestive tract1

Two major types

Ulcerativecolitis (UC)

a�ects the largeintestine and

rectum1

Crohn’sdisease (CD)

can a�ect anypart of the

digestive tract1

Two major types

Ulcerativecolitis (UC)

a�ects the largeintestine and

rectum1

Crohn’sDisease (CD)

can a�ect anypart of the

digestive tract

Two major types

UlcerativeColitis (UC)a�ects the large

intestine andrectum

3

WHAT ARE THE SYMPTOMS OF IBD?

PATIENTS WITH CD AND UC MAY EXPERIENCE MANY OF THE SAME SYMPTOMS5 Symptoms of CD and UC include

Symptoms CD UC

Abdominal pain X X

Anemia X X

Anorexia X X

Blood and mucus in stool X X

Diarrhea X X

Fever X X

Weight loss X X

Impact of IBD symptoms Patients with CD Patients with UC

Experienced flare-ups every few months 71.0% 67.7%Affected ability to perform job functions 71.7% 65.6%Caused change in job or job responsibilities 37.6% 27.6%

THESE SYMPTOMS MAY IMPACT A PATIENT’S ABILITY TO WORK6 From a survey of 5576 members of 7 national IBD organizations affiliated with the European Federation of Crohn’s and Ulcerative Colitis Associations

UNFORTUNATELY, PATIENTS WITH IBD ARE OFTEN MISDIAGNOSED7 • IBD is sometimes confused with irritable bowel syndrome (IBS)7 • While symptoms are similar, IBS does not cause inflammation and does not lead to irreversible

damage of the intestines, or the harmful complications caused by IBD, such as an increased risk of colorectal cancer 4

4

3 million (2015)8*

Estimated Number of Americans With IBD:

Estimated New Casesof IBD Every Year:

As many as 70,0002+

* Based on aggregated survey data from the 2015 and 2016 National Health Interview Survey (NHIS), a cross-sectional household health survey of the civilian, noninstitutionalized population in the United States.8

† Age-adjusted % (95% confidence interval [CI]): 45-64 years of age, 1.5%. Estimates are age-adjusted using the projected 2000 US population as the standard population.8

NEARLY 2% OF YOUR MEMBERS 45-64 YEARS OF AGE MAY HAVE IBD8†

IBD ONSET HAPPENS AT A YOUNG AGE2 • Average age of peak onset is 15 to 35 years of age, although the disease can present at any time

OTHER RISK FACTORS ASSOCIATED WITH IBD• IBD is found more often in northern climates and in urban areas2 • IBD is more common in Caucasian and Ashkenazic Jewish people9 • CD and UC affect both men and women—UC is more common in men2,9

WHO GETS IBD?

THE INCIDENCE OF IBD IN THE UNITED STATES IS INCREASING

5

WHAT ARE THE HEALTH RISKS OF IBD?

OTHER SERIOUS CONDITIONS ARE ASSOCIATED WITH IBD, EACH REQUIRING SPECIALIZED CARE

Additional chronic inflammatory conditions are higher in patients with IBD than in those without10*

†Based on aggregated survey data from the 2015 and 2016 National Health Interview Survey (NHIS), a cross-sectional household health survey of the civilian, noninstitutionalized population in the United States.8 ‡Statistically significant (p<0.05) difference between adults with IBD and adults without IBD. Estimates were age-adjusted using the projected 2000 US population as the standard population and 4 age groups: 18–24, 25–44, 45–64, and ≥65 years.8 §Age-adjusted % (95% CI), adults with IBD: 19.2 (16.3–22.5), adults without IBD: 12.0 (11.7–12.4). Cardiovascular disease included a history of any of the following conditions: coronary heart disease, angina, myocardial infarction, stroke, or any heart disease.8 IIAge-adjusted % (95% CI), adults with IBD: 7.4 (5.4–10.0), adults without IBD: 3.4 (3.2–3.6). Serious psychological distress was based on responses to 6 questions that asked how often a respondent experienced certain symptoms (feeling so sad nothing could cheer you up; nervous; restless or fidgety; hopeless; that everything was an effort; worthless) of psychological distress during the past 30 days.8 ¶Age-adjusted % (95% CI), adults with IBD: 5.2 (3.7–7.2), adults without IBD: 1.7 (1.6–1.8). Any liver condition was defined as an affirmative response to the question “During the past 12 months, have you been told by a doctor or other health professional that you had any kind of liver condition?”8 #Age-adjusted % (95% CI), adults with IBD: 26.0 (22.2–30.3), adults without IBD: 5.5 (5.3–5.7). Ulcer was defined as an affirmative response to the question “Have you ever been told by a doctor or other health professional that you had an ulcer?”8

* Based on a large, US cross-sectional study: asthma (odds ratio [OR] 1.5, 95% CI 1.4–1.6), psoriasis (OR 1.7, 95% CI 1.5–2.0), rheumatoid arthritis (OR 1.9, 95% CI 1.5–2.3), and multiple sclerosis (OR 2.3, 95% CI 1.6–3.3).10

1.5x MORE LIKELY

to have Asthma

to have Psoriasis

1.7x MORE LIKELY

to have Rheumatoid

Arthritis

1.9x MORE LIKELY

to have Multiple Sclerosis

2.3x MORE LIKELY

Any liver dysfunctionReported 3.1x (more frequently by adults with IBD) than by those without IBD‡¶

UlcersReported 4.7x (more frequently by adults with IBD) than by those without IBD‡#

Patients with IBD are also at risk for other conditions8†

Serious psychological distressReported 2.2x (more frequently by adults with IBD) than by those without IBD‡II

Cardiovascular diseaseReported 1.6x (more frequently by adults with IBD) than by those without IBD‡§

6

WHAT ARE THE COSTS ASSOCIATED WITH IBD?

*Results were obtained through a systematic review of 33 full papers and 5 abstracts on the cost of CD.13 † Data for 41 US-based large companies were utilized from the OptumHealth Reporting and Insights claims database from 2005-2013.

A generalized linear model regression were used to estimate the impact of disease on the magnitude of costs. The model controlled for factors that were significantly different (p<0.05) between UC patients and controls at baseline.14

CROHN’S DISEASE13*

~$19,619 TOTAL COSTS PER PATIENT/YEARULCERATIVE COLITIS14†

~$25,737 TOTAL COSTS PER PATIENT/YEAR

Direct costs $18,477

Direct costs $15,548

CROHN’S DISEASE13*

~$19,619 TOTAL COSTS PER PATIENT/YEARULCERATIVE COLITIS14†

~$25,737 TOTAL COSTS PER PATIENT/YEAR

Direct costs $18,477

Direct costs $15,548

One-year health care costs for a patient with IBD were up to 5 times higher than the average costs for a commercially insured patient without IBD12

IN 2014, HEALTH CARE COSTS FOR IBD RANGED FROM

$14.6-$31.6 BILLION11

7

HOW DOES IBD IMPACT HEALTHCARE UTILIZATION?

PATIENTS WITH IBD HAVE HIGHER RESOURCE UTILIZATION THAN PATIENTS WITHOUT IBDIBD was the cause of

Based on an analysis of a large claims database when compared with control patients without IBD*:

• Patients with CD had ~5 additional office visits per year16 • Patients with UC had ~3.6 additional office visits per year16

Surgical treatment substantially increases the costs of care

• 75% of patients with CD and 25% with UC will eventually require surgery17 – CD patients incurred nearly 4x the costs of those not requiring surgery ($60,146 vs $15,698)12† – UC patients incurred nearly 6x the costs of those not requiring surgery ($72,415 vs $12,822)12†

EMERGENCY DEPARTMENT (ED) USE IS GREATER THAN THAT OF NON-IBD PATIENTS16 Data from 2003 and 2004*:

• Patients with CD had >20 additional ED visits per 100 patients each year (P <0.001) • Patients with UC had >10 additional ED visits per 100 patients each year (P <0.001)

* Inpatient, office-based, emergency, and endoscopy services occurring in 2003 and 2004 in 9056 patients with CD, 10,364 patients with UC, and 52,989 controls were matched for age, gender, and region from 87 different health plans in 33 states. Mean annual ED visits per 100 patients with CD was 36.0, vs 15.1 for the CD controls. Mean annual ED visits per 100 patients with UC was 26.2 vs 15.7 for the UC controls.16 †Mean 12-month expenditures; P<0.001.12

1,816,000 (2004) physician visits15

H

294,000 (2010) hospitalizations15

8

* Based on a systematic review of 14 published studies originating in Australia, Canada, Greece, Spain, Switzerland, The Netherlands, Finland, and Sweden.20

IBD CAN HAVE SIGNIFICANT EFFECTS ON DISABILITY BENEFITS AND WORK PRODUCTIVITY18-20

WHAT IS THE EFFECT OF IBD ON ABSENCE AND PRODUCTIVITY?

EMPLOYEES WITH IBD WERE FOUND TO BE MORE LIKELY TO MISS TIME FROM WORK THAN PATIENTS WITHOUT IBD18 From an analysis of US Medical Expenditure Panel Survey data of employed individuals aged 18-64 years (1996-2006)18: • Greater probability of missing time from work due to illness

– 71.5% vs 58.2% (P<0.001) • Lose more work days annually

– 13.38 vs 9.89 days (P = 0.044)

THEY MAY BE LESS PRODUCTIVE AT WORKFrom a survey of 146 employed patients with IBD attending the UCLA Center for Inflammatory Bowel Diseases19

nearly 5 out of 10

6 out of 10

EMPLOYEES ADMI�ED TO HAVING GONE TO WORK WHILE SICK19

SAID THEIR WORK PERFORMANCEHAD BEEN AFFECTED BY FATIGUE19

nearly 5 out of 10

6 out of 10

EMPLOYEES ADMI�ED TO HAVING GONE TO WORK WHILE SICK19

SAID THEIR WORK PERFORMANCEHAD BEEN AFFECTED BY FATIGUE19

EMPLOYEES WITH IBD MAY UTILIZE MORE DISABILITY BENEFITS• Employees with IBD were more than twice as likely to receive short-term disability benefits

than those without IBD11 • 16%–27% of employees with CD and 13%–18% of employees with UC reported receiving

long-term disability benefits 20*

9

WHAT DO MEMBERS WITH IBD NEED TO DO?

TAKE ACTION—RECOGNIZE SYMPTOMS AND SEEK THE CARE OF A SPECIALIST

• An accurate diagnosis is best achieved by a gastroenterologist, particularly one who specializes in IBD21

• It may take up to 2 years after symptom onset before IBD is correctly diagnosed22

MANY PATIENTS WITH IBD ARE NOT DIAGNOSED RIGHT AWAYResults from one case-control study from a general practice research database in the United Kingdom suggest that about 10% of IBD patients receive a misdiagnosis of IBS prior to being diagnosed with IBD23

MEMBERS NEED EDUCATION AND ACCESS TO CARE FROM SPECIALISTS WHO CAN DIAGNOSE AND

MANAGE THEIR COMPLEX DISEASE

Potential consequences of delayed diagnosis:• Irreversible damage to intestine

as early as 4 months24 • Increased need for surgery24 • Increased use of ED services25

AT TIME OF DIAGNOSIS

OF PATIENTS WITH CDALREADY HAVE COMPLICATIONS2

OF PATIENTS WITH UCHAVE SEVERE DISEASE2

33%UP TO

19%UP TO

!

10

WHAT SHOULD AN EMPLOYER DO?

BE SURE YOUR MEMBERS WITH IBD HAVE ACCESS TO THE SUPPORT, EDUCATION, AND CARE THEY NEED

STEP 2:Provide your members with appropriate educational resources

• To help those who are undiagnosed seek the care they need

• To help those diagnosed with IBD better manage their condition

Talk to your benefits partners about the right plan design to ensure access to appropriate care

• Members with IBD may need care from a team of health care providers who specialize in IBD and its complications- For example, gastroenterologists, IBD specialists,

nutritionists, and dieticians

• Ensure access to laboratory services for diagnosis, disease assessment, and monitoring- For example, blood tests, endoscopy, imaging

• Medication, including specialty medications, may be needed for the management of IBD

• Some members will require medical procedures such as surgery

• Additional supportive care may be needed

STEP 1 :

11

WHAT RESOURCES CAN YOU PROVIDE TO YOUR EMPLOYEES?

DISTRIBUTE EDUCATIONAL RESOURCES THAT SUPPORT AND EMPOWER MEMBERS WITH IBDBrochures and websites you can provide to your employees.

Crohn’s & Colitis https://www.crohnsandcolitis.com

Crohn’s & Colitis Foundation http://www.crohnscolitisfoundation.org

LIVING A HEALTHY LIFESTYLE WITH INFLAMMATORY BOWEL DISEASE (IBD)

Living a Healthy Lifestyle With Inflammatory Bowel

Disease (IBD)

HELPING A LOVED ONE COPE WITH INFLAMMATORY BOWEL DISEASE (IBD)

Caregivers, including a spouse, parent, neighbor and others, can contribute to an IBD patient’s well-being and play a significant role as a part of his/her health care team.

· IBD is the name given to a group of inflammatory diseases of the gastrointestinal (GI) tract1

· The 2 major types of IBD are Crohn’s disease and ulcerative colitis2

· IBD is different than irritable bowel syndrome (IBS)2

· IBD is a lifelong condition1

· Most patients with IBD can continue to perform daily activities. However, at times, the pain and symptoms of IBD can limit what the patient can do for himself/herself3

· Your loved one with IBD may need your help with some daily activities when symptoms of IBD flare up

· You can help your loved one cope with IBD

Tips for Helping a Loved One Cope With IBD

· Learn as much as you can about IBD· Listen to your loved one who has IBD. Allow him/her to share as much or as little as he/she is

comfortable sharing· Offer to go with your loved one to doctor’s appointments or medical procedures· Encourage your loved one to follow the dietary plan developed with his/her nutritionist· Help your loved one locate restrooms in public places such as restaurants, shopping

areas, or on public transportation· Join a support group. These groups are for IBD

patients, family, and friends· Partner with your loved one to reduce stress.

Stress has negative effects on everyone · Offer to accompany your loved one to a

relaxing activity, or make it possible for him/her to have some meditation or rest time

Remember, loved ones play an important role in the support and care of IBD patients.

Click here to add logo

Helping a Loved One Cope With Inflammatory Bowel

Disease (IBD)

INFLAMMATORY BOWEL DISEASE (IBD)MAKING THE MOST OF THE RELATIONSHIP WITH YOUR GASTROENTEROLOGIST

Inflammatory Bowel Disease (IBD): Making the Most of the Relationship With Your

Gastroenterologist

References1. Centers for Disease Control. What is inflammatory bowel disease (IBD)? https://www.cdc.gov/ibd/what-is-ibd.htm. Accessed November 8, 2018. 2. Crohn’s & Colitis Foundation of America. The Facts About Inflammatory Bowel Diseases. http://www.crohnscolitisfoundation.org/assets/pdfs/updatedibdfactbook.pdf. Accessed November 8, 2018. 3. Goldman L, Schafer AI. Inflammatory bowel disease. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier; 2015:850-973. 4. Crohn’s & Colitis Foundation of America. Inflammatory Bowel Disease and Irritable Bowel Syndrome: Similarities and Differences. http://www.crohnscolitisfoundation.org/assets/pdfs/ibd-and-irritable-bowel.pdf. Accessed November 8, 2018. 5. Shah A, St. Clair EW. Inflammatory bowel disease. In: Shanahan JF, Davis KJ, eds. Harrison’s Principles of Internal Medicine. 20th ed. New York, NY: McGraw Hill Medical; 2018: 1-37. 6. Ghosh S, Mitchell R. Impact of inflammatory bowel disease on quality of life: Results of the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA) patient survey. J Crohns Colitis. 2007;1(1):10–20. 7. Schwartz D. Patient Care website. Inflammatory bowel disease: 5 things primary care doctors need to know now. http:/patientcareonline.com/gastrointestinal-disorders/inflammatory-bowel-disease-5-things-primary-care-doctors-need-know-now. Accessed December 20, 2018. 8. Xu F, Dahlhamer JM, Zammitti EP, Wheaton AG, Croft JB. Health-risk behaviors and chronic conditions among adults with inflammatory bowel disease — United States, 2015 and 2016. MMWR Morb Mortal Wkly Rep. 2018;67:190–195. 9. Centers for Disease Control and Prevention. Epidemiology of the IBD. https://www.cdc.gov/ibd/ibd-epidemiology.htm. Accessed December 20, 2018. 10. Wilson JC, Furlano RI, Jick SS, Meier CR. Inflammatory bowel disease and the risk of autoimmune diseases. J Crohns Colitis. 2016;186–193. 11. Mehta F. Report: economic implications of inflammatory bowel disease and its management. Am J Manag Care. 2016;22(3 Suppl):s51-s60. 12. Gibson TB, Ng E, Ozminkowski RJ, et al. The direct and indirect cost burden of Crohn’s disease and ulcerative colitis. J Occup Environ Med. 2008;50(11):1261–1272. 13. Floyd DN, Langham S, Séverac HC et al. The economic and quality-of-life burden of Crohn’s Disease in Europe and the United States, 2000 to 2013: a systematic review. Dig Dis Sci. 2015;60:299-312. 14. Cohen R, Skup M, Ozbay AB, et al. Direct and indirect healthcare resource utilization and costs associated with ulcerative colitis in a privately-insured employed population in the US. J Med Econ. 2015;18(6):447-456. 15. National Institute of Diabetes and Digestive and Kidney Diseases. Digestive diseases statistics for the United States. https://www.niddk.nih.gov/health-information/health-statistics/digestive-diseases. Updated November 2014. Accessed December 20, 2018. 16. Kappelman MD, Rifas-Shiman SL, Porter CQ, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135(6):1907–1913. 17. Centers for Disease Control and Prevention. An expensive disease without a cure. http://www.cdc.gov/ibd/pdf/inflammatory-bowel-disease-an-expensive-disease.pdf. Accessed November 8, 2018. 18. Gunnarsson C, Chen J, Rizzo JA, Ladapo JA, Naim A, Lofland JH. The employee absenteeism costs of inflammatory bowel disease: evidence from US national survey data. J Occup Environ Med. 2013;55(4):393–401. 19. European Crohn’s and Colitis Organisation. Z and A, Van Deen WK, Ha CH, et al. DOP026. Work related problems and impaired productivity in patients with inflammatory bowel disease (IBD). Digital oral presentation, 9th Congress of the European Crohn’s and Colitis Organisation. Copenhagen, Denmark: February 20–22, 2014. https://www.ecco-ibd.eu/index.php/publications/congress-abstract-s/abstracts-2014/item/dop026-work-related-problems-and-impaired-productivity-in-patients-with-inflammatory-bowel-diseases-ibd.html. Accessed November 8, 2018. 20. Busch K, Sonnenberg A, Bansback N. Impact of inflammatory bowel disease on disability. Curr Gastroenterol Rep. 2014;16(10):414. 21. Crohn’s & Colitis Foundation of America. Diagnosing and Managing IBD. http://www.crohnscolitisfoundation.org/assets/pdfs/diagnosing-and-managing-ibd.pdf. Accessed August 2, 2017. 22. Porter CK, Cash BD, Pimentel M, Akinseye A, Riddle MS. Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome. BMC Gastroenterol. 2012;12:55. 23. Card TR, Siffledeen J, Fleming KM. Are IBD patients more likely to have a prior diagnosis of irritable bowel syndrome? Report of a case-control study in the General Practice Research Database. United European Gastroenterol J. 2014;2(6):505-512. 24. Schoepfer AM, Dehlavi MA, Fournier N, et al. Diagnostic delay in Crohn’s disease is associated with a complicated disease course and increased operation rate. Am J Gastroenterol. 2013;108(11):1744–1753. 25. Ananthakrishnan AN, McGinley EL, Saeian K, Binion DG. Trends in ambulatory and emergency room visits for inflammatory bowel diseases in the United States: 1994–2005. Am J Gastroenterol. 2010;105(2):363-370.

INFLAMMATORY BOWEL DISEASE IS A CHRONIC, DEBILITATING DISEASE THAT

MAY BE AFFECTING EMPLOYEE PERFORMANCE IN YOUR ORGANIZATION

©2019 AbbVie Inc. North Chicago, IL 60064 US-IMMG-190057 February 2019