2013-2019 年美国商业保险患者炎症性肠病治疗起始后结肠镜检查的应用。
Utilization of Colonoscopy Following Treatment Initiation in U.S. Commercially Insured Patients With Inflammatory Bowel Disease, 2013-2019.
机构信息
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Pediatric Gastroenterology, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
出版信息
Inflamm Bowel Dis. 2023 May 2;29(5):735-743. doi: 10.1093/ibd/izac136.
BACKGROUND
Evaluation of mucosal healing with colonoscopy is recommended for inflammatory bowel disease (IBD) management; however, little is known about real-world use of treat-to-target monitoring following IBD treatment initiation. We aimed to estimate the proportion of U.S. commercially insured IBD patients who receive colonoscopy in the 3 to 15 months after initiating treatment.
METHODS
We identified IBD patients, 18 to 64 years of age, in the IBM MarketScan Commercial Claims and Encounters database as those with ≥3 IBD diagnoses prior to initiation of biologic, small molecule, or immunomodulatory treatment. We excluded patients with prior colectomy and with rheumatologic and other indications for these therapies. Colonoscopies were identified using International Classification of Diseases-Ninth Revision, International Classification of Diseases-Tenth Revision, and Current Procedural Terminology procedure codes. We used Kaplan-Meier methods to estimate the proportion of newly treated IBD patients who received colonoscopy in the 3 to 6 months, 3 to 12 months, and 3 to 15 months following treatment initiation, and stratified trends by year, patient age and sex, and region.
RESULTS
From 2013 to 2019, we identified 39 734 initiators of IBD medications (51.9% female, mean age 39.4 years). We observed similar colonoscopy incidence among ulcerative colitis patients (3-6 months: 14.2% [95% confidence interval (CI), 13.6%-14.8%]; 3-12 months: 37.7% [95% CI, 36.8%-38.6%]; 3-15 months: 46.1% [95% CI, 45.2%-47.1%]) and Crohn's disease patients (3-6 months: 11.2% [95% CI, 10.8%-11.6%]; 3-12 months: 32.2% [95% CI, 31.5%-32.9%]; 3-15 months: CD: 40.1% [95% CI, 39.3%-40.8%]). Overall colonoscopy use was slightly higher among women, patients in the Northeast, and those initiating newer biologic therapies.
CONCLUSIONS
Fewer than half of newly treated IBD patients underwent colonoscopy within 3 to 15 months of initiating new treatment, suggesting low uptake of treat-to-target endoscopic disease monitoring in real-world practice.
背景
结肠镜检查评估黏膜愈合情况被推荐用于炎症性肠病（IBD）的管理；然而，对于 IBD 治疗启动后的靶向治疗监测的实际应用知之甚少。我们旨在估计美国商业保险 IBD 患者中，在开始治疗后 3 至 15 个月内接受结肠镜检查的比例。
方法
我们在 IBM MarketScan 商业索赔和就诊数据库中确定了 18 至 64 岁的 IBD 患者，这些患者在开始使用生物制剂、小分子或免疫调节剂治疗之前至少有 3 次 IBD 诊断。我们排除了既往接受过结肠切除术和有风湿性疾病及其他这些治疗适应证的患者。结肠镜检查使用国际疾病分类第 9 版、国际疾病分类第 10 版和当前操作术语程序代码进行识别。我们使用 Kaplan-Meier 方法估计新治疗的 IBD 患者在治疗开始后 3 至 6 个月、3 至 12 个月和 3 至 15 个月内接受结肠镜检查的比例，并按年份、患者年龄和性别以及地区对趋势进行分层。
结果
2013 年至 2019 年，我们确定了 39734 例 IBD 药物治疗的启动者（51.9%为女性，平均年龄 39.4 岁）。我们观察到溃疡性结肠炎患者的结肠镜检查发生率相似（3-6 个月：14.2%[95%置信区间（CI），13.6%-14.8%]；3-12 个月：37.7%[95% CI，36.8%-38.6%]；3-15 个月：46.1%[95% CI，45.2%-47.1%]）和克罗恩病患者（3-6 个月：11.2%[95% CI，10.8%-11.6%]；3-12 个月：32.2%[95% CI，31.5%-32.9%]；3-15 个月：40.1%[95% CI，39.3%-40.8%]）。女性、东北地区的患者和新启动生物治疗的患者的总体结肠镜检查使用率略高。
结论
新治疗的 IBD 患者中，不到一半的患者在开始治疗后 3 至 15 个月内接受结肠镜检查，这表明在实际实践中，针对目标的内镜疾病监测的接受度较低。
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