The Economic Impact of Irritable Bowel Syndrome

J. M. Inadomi, M. B. Fennerty, D. Bjorkman

Disclosures

Aliment Pharmacol Ther. 2003;18(7) 

In This Article

Summary and Introduction

Background: Although little mortality is associated with irritable bowel syndrome, curative therapy does not exist and thus the economic impact of this disorder may be considerable.
Methods: A systematic review of the literature was performed. Studies were included if their focus was irritable bowel syndrome, and direct and/or productivity (indirect) costs were reported. Two investigators abstracted the data independently.
Results: One hundred and seventy-four studies were retrieved by the search; 11 fulfilled all criteria for entry into the review. The mean direct costs of irritable bowel syndrome management were reported to be UK£90, Canadian$259 and US$619 per patient annually, with total annual direct costs related to irritable bowel syndrome of £45.6 million (UK) and $1.35 billion (USA). Direct resource consumption of all health care for irritable bowel syndrome patients ranged from US$742 to US$3166. Productivity costs ranged from US$335 to US$748, with total annual costs of $205 million estimated in the USA. Annual expenditure for all health care, in addition to expenditure limited to gastrointestinal disorders, was significantly higher in irritable bowel syndrome patients than in control populations.
Conclusions: Despite the lack of significant mortality, irritable bowel syndrome is associated with high direct and productivity costs. Irritable bowel syndrome patients consume more gastrointestinal-related and more total health care resources than non-irritable bowel syndrome controls, and sustain significantly greater productivity losses.

Irritable bowel syndrome is a prevalent functional gastrointestinal disorder characterized by abdominal pain or discomfort associated with abnormal patterns of defecation.[19] Although not a cause of significant mortality, irritable bowel syndrome has been shown to be associated with significant detrimental effects on the health-related quality of life.[10,11] Definitive treatment of this disorder remains elusive. Although a variety of pharmacological agents have been utilized to treat irritable bowel syndrome, few have been subject to rigorous testing.[12] As a result of the high prevalence, detrimental impact on the quality of life and absence of curative therapy, irritable bowel syndrome has the potential for creating tremendous economic pressure on the health care system.[13,14,15]

It has been estimated that 3.5 million physician visits are made annually in the USA for irritable bowel syndrome, accounting for up to 25% of all patients seen in gastroenterologists' practice.[16] Irritable bowel syndrome is the seventh most prevalent diagnosis amongst all physicians and the most common diagnosis made by gastroenterologists.[16] Despite these impressive numbers, it has been estimated that only 10-25% of all subjects with symptoms consistent with irritable bowel syndrome seek medical care.[13,17,18] There is therefore the potential for substantial economic impact resulting from the direct consumption of health care resources, as well as the loss of productivity and reduction in the quality of life, even amongst those not seeking health care.

Cost determination is a complex process due to multiple factors. The identification of the cost of providing a service requires an understanding of the perspective of the analysis. Potentially different perspectives include those of a third-party payer (insurance company, government), a hospital, an individual patient or society as a whole. Costs must be differentiated from charges, which vary greatly and may include a mark-up for profit and cost shifting for coverage of non-reimbursed services or other losses.[19,20,21] It must be stated what direct health care costs are included in the analysis, such as hospitalizations, out-patient or emergency visits, procedures and medication. Differentiation between the resources utilized for diagnostic evaluation and the resources consumed for therapeutic interventions should be performed. In addition, assumptions regarding the direct non-health care and productivity (indirect) costs that are incorporated must be provided. Finally, costs may be derived from hospital accounting systems, claims databases, insurance reimbursements or other administrative databases that were not originally designed for research purposes. Despite these limitations and challenges, it remains an important task to estimate the magnitude of resource expenditure required to manage irritable bowel syndrome so that the economic impact of this disorder may be compared with that of other diseases, and any new treatment interventions may be evaluated for efficacy and economic viability.

We performed a systematic review of the published literature with the primary intent of determining the economic impact of irritable bowel syndrome. Specifically, we sought to determine the total costs, including direct and productivity (indirect) costs, associated with irritable bowel syndrome in adults. In addition, we aimed to determine what types of cost were included in published economic analyses of irritable bowel syndrome. Our search included international sources of data and was not restricted to the monetary description of economic impact.

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