The Economic Impact of Irritable Bowel Syndrome

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


Aliment Pharmacol Ther. 2003;18(7) 

In This Article


A systematic review of the literature was performed to ascertain the economic impact of irritable bowel syndrome. Guidelines for the conduct of systematic reviews have been published previously.[22,23] The focused clinical question we wished to address was: 'what are the direct, productivity (indirect) and total costs associated with irritable bowel syndrome?' A computer-assisted search of five online bibliographic databases was performed. The MEDLINE database from 1966 to June 2002, the EMBASE database from 1988 to 2002, Current Contents, the Cochrane Library and PreMEDLINE were interrogated using the MESH term (exploded) Colonic disease, functional OR keywords irritable bowel syndrome OR irritable colon OR spastic colon AND MESH terms (exploded) cost and cost analysis; cost of illness; health care costs; cost-benefit analysis; economics; economics, hospital; economics, medical; economics, pharmaceutical OR keywords cost OR costs. Bibliographies of identified articles were also reviewed to trace other potential studies not revealed by the search.

Requirements for study inclusion in this systematic review included the following: (i) disease limited to irritable bowel syndrome (chronic abdominal pain, pelvic pain or dyspepsia without irritable bowel syndrome were excluded); (ii) presentation of economic impact, including direct or productivity (indirect) costs; (iii) adult population; (iv) original data (reviews of other studies excluded); and (v) English language. Costs were not limited to the US currency and could be expressed in non-monetary terms. As study assessment could not be performed on abstracts, this study was limited to publications in full manuscript form. One investigator (J.M.I.) reviewed all the articles captured in the search for relevance to the study question.

A standardized data abstraction form was prepared for this study. Two reviewers (J.M.I. and M.B.F.) performed independent data abstraction for each manuscript meeting the entry criteria. The data abstracted included: manuscript authors, journal, year of publication, study setting (geographical location and study environment), patient population, method of verification of irritable bowel syndrome, method of cost calculation, standardized cost year, study perspective (third-party insurer, societal, hospital or practice), direct costs, productivity (indirect) costs and total costs. Discrepancies in data abstraction were resolved by consensus.

Due to the heterogeneity of the basis upon which costs amongst studies were identified, a quantitative meta-analysis to aggregate cost data could not be performed. Specifically, the resources used to derive direct health care-related costs and productivity costs varied substantially between the studies, as did the monetary basis ($US, £UK, $Canadian). The data are presented quantitatively and descriptively in tabular form. The manner in which costs were defined is detailed in the Appendix. It should be noted that no study attempted to quantify intangible costs (potential costs associated with decrements in the quality of life), and thus these were not included in this review.


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