EP722 - Financial Toxicity Associated With Inflammatory Bowel Disease: A National Health Interview Survey Study

Purpose/Background: More than 3 million Americans are affected by inflammatory bowel disease (IBD), which imposes a significant economic burden. However, the specific financial impact on individual patients-including financial distress and toxicity-remains poorly understood. Financial toxicity (FT) is increasingly recognized as a devastating consequence of medical care in the United States. It is defined as the objective financial burden and subjective financial distress patients experience as a result of their medical treatment. FT is not limited to the direct cost of care, but also encompasses indirect consequences such as modified employment and reduced income. This study aims to characterize the FT associated with inflammatory bowel disease (IBD) using the National Health Interview Survey (NHIS).

Methods/Interventions: A retrospective cross-sectional analysis of the NHIS from years 2023-2024 was performed. Respondents with a history of Crohn's disease (CD) or ulcerative colitis (UC) were included. A random sample of age-matched controls with no IBD history was selected for comparison. Covariates assessed included age, sex, race, ethnicity, insurance coverage status, and household region. The primary endpoint, FT, was assessed using a composite score created from 12 dichotomous FT-related NHIS items, with each response coded as either yes (1) or no (0). Composite FT scores, determined by the summation of the 12 FT items, were categorized into None (0), Moderate (1-6), or High (7-12) FT. Rates of FT, and individual survey responses, were compared using Pearson's Chi-squared statistic.

Results/Outcomes: 1,126 patients with a history of IBD were identified. IBD patients did not differ from controls by age, household region, or insurance coverage status. However, IBD patients were more frequently White (82.8% vs 77.4%, p=0.003), less frequently Black/African American (6.8 vs 11.6%, p=0.003) or Hispanic (5.2% vs 8.2%, p=0.005), and more frequently female than controls (60.4% vs 54.4%, p=0.004). IBD patients also had significantly more emergency room visits (p < 0.001), and overnight hospitalizations (p < 0.001) in the last 12 months than controls. FT was significantly increased in people with a history of IBD (Table 1). High FT (score 7-12) was more than doubled in the IBD cohort compared to controls (4.70% vs 2.0%, p< 0.001). Specifically, IBD patients had higher rates of problems paying medical bills (15.4% vs 8.7%, p< 0.001), inability to pay medical bills (9.3% vs 5.3%, p< 0.001), delaying medical care due to cost (10.6% vs 6.2%, p< 0.001) and skipping medication doses to save money (6.0% vs 3.9%, p< 0.001). Additionally, IBD respondents experienced significantly decreased food security (p=0.002) and overall poorer health status (p < 0.001) than controls.

Conclusion/Discussion: Patients with IBD suffer significant financial toxicity, which confers lasting impacts on access to health care, food security, and overall health status. For colorectal surgeons managing medically refractory IBD, financial barriers may impede optimal pre-operative optimization and adherence to critical post-operative regimens. Clinicians must be aware of these adverse economic effects and the financial barriers to care that patients with IBD face. Efforts to reduce FT of IBD treatment are warranted and may yield long-term benefits at the population level by improving patient outcomes across medical and surgical management.

Table 1
Financial Toxicity experienced by patients with IBD compared to age-matched controls