Anemia Severity Associated with Increased Healthcare Utilization and Costs in Inflammatory Bowel Disease

Dig Dis Sci. 2021 Aug;66(8):2555-2563. doi: 10.1007/s10620-020-06590-y. Epub 2020 Sep 5.

Hanna Blaney 1, Peter Vu 2, Antony Mathew 2, Robin Snelling 2, Julie England 2, Camille Duong 2, Kendall Hammonds 3, Christopher Johnson 4


Author information

  • 1Department of Internal Medicine, Texas A&M Health Science Center College of Medicine, 2401 S 31st St, Temple, TX, 76508, USA.
  • 2Texas A&M Health Science Center College of Medicine, 2401 S 31st St, Temple, TX, 76508, USA.
  • 3Department of Biostatistics, Baylor Scott and White Research Institute, 2401 S 31st St, Temple, TX, 76508, USA.
  • 4Division of Gastroenterology, Texas A&M Health Science Center College of Medicine, 2401 S 31st St, Temple, TX, 76508, USA. Christopher.johnson@bswhealth.org.


Background: Anemia is a common systemic complication of inflammatory bowel disease (IBD) and is associated with worse disease outcomes, quality of life, and higher healthcare costs.

Aims: The purpose of this study was to determine how anemia severity impacts healthcare resource utilization and if treatment of anemia was associated with reduced utilization and costs.

Methods: Retrospective chart review of adult patients managed by gastroenterology between 2014 and 2018 at a tertiary referral center.

Results: The records of 1763 patients with IBD were included in the analysis, with 966 (55%) patients with CD, 799 (44%) with UC, and 18 (1%) with unspecified IBD. Of these patients, 951 (54%) had anemia. Patients with anemia had significantly more hospitalizations, increased length of stays, more ER, GI, and PCP visits, as well as higher costs when compared to patients with IBD without anemia. Patients with more severe anemia had more healthcare utilization and incurred even higher total costs. Treatment with IV or oral iron did not lower overall utilization or costs, when compared to patients with anemia who did not receive treatment (p < 0.0001).

Conclusions: Our results demonstrate that the presence of anemia is correlated with increased resource utilization in patients with IBD, with increase in anemia severity associated with higher utilization and costs. Anemia has been associated with increased disease activity and could represent a marker of more severe disease, possibly explaining these associations. Our results suggest that treating anemia is associated with increased resource utilization; however, further research is needed to investigate this relationship.

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