Utilization Patterns and Net Direct Medical Cost to Medicaid of Irritable Bowel Syndrome

Bradley C. Martin; Rahul Ganguly; Sandhya Pannicker; Feride Frech; Victoria Barghout


Curr Med Res Opin. 2003;19(8) 

In This Article

Summary and Introduction

Background: Patients with irritable bowel syndrome are frequent users of the health care system.
Design and Methods: This retrospective matched case-control study assessed the economic impact of irritable bowel syndrome on the Medicaid program by comparing the health care utilization and expenditures of Medicaid patients with irritable bowel syndrome in California and North Carolina with age-, sex-, and race-matched control groups without the syndrome.
Results: Average annual Medicaid expenditures per case of diagnosed irritable bowel syndrome were $2952 and $5908 in California and North Carolina, respectively; corresponding unadjusted net incremental expenditures were $962 and $2191, respectively. In both states, patients with irritable bowel syndrome incurred greater costs than controls for physician visits, outpatient visits, and prescription drugs.
Conclusions: Irritable bowel syndrome was shown to impose an economic burden on the Medicaid program. The cost of treating patients with irritable bowel syndrome is higher than the cost of treating matched ambulatory Medicaid recipients without the condition.

Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder characterized by symptoms of abdominal pain and discomfort and altered bowel function (constipation, diarrhea, or both in alternation) in the absence of organic disease.[1] The IBS disorder is one that is characterized by intermittent episodic symptoms that may remit and re-emerge over time.[2] The prevalence of IBS in the adult US population has been estimated to be between 3 and 20% which varies greatly depending on the diagnostic criteria used and the methods used to detect IBS cases.[2] Women are predominantly affected, at an approximate ratio to men of 2 : 1[1,2,4,5] and there is no consistent relationship between IBS prevalence and age,[2] though some have suggested that persons who are middle- aged are more likely to have IBS.[6] IBS also appears to afflict more whites than blacks in the USA.[6] A review of the natural history of IBS suggests that 38% of IBS patients may not have IBS symptoms at 1 year follow-up; however, the prevalence of IBS appears to remain fairly stable from year to year as incident IBS cases emerge.[2]

To facilitate more appropriate treatment and as a guide for diagnosing IBS and ruling out other potential diseases, IBS patients are often categorized by the predominant symptom(s): diarrhea, constipation, both diarrhea and constipation, or abdominal pain without constipation or diarrhea.[7,8] The prevalence of constipation predominant, diarrhea predominant, and both, are approximately equal at about a 5% prevalence, while abdominal pain without diarrhea or constipation is slightly less prevalent at approximately 4%.[2]

Although surveys indicate that only a small percentage (10-30%) of patients with IBS seek medical care,[1,3] patients with IBS are frequent users of the health care system. IBS accounts for 12% and 28% of diagnoses made by primary care physicians and gastroenterologists, respectively.[1,9] In fact, IBS is the diagnosis most commonly made by gastroenterologists.[10]

The annual cost associated with the diagnosis and treatment of IBS is considerable. Estimates vary, but the total (direct[11] and indirect[12]) annual cost of IBS in the USA is approximately $30 billion. This figure includes primary care and specialist physician visits, outpatient and inpatient care, and diagnostic testing, but it excludes prescription and nonprescription medications.

IBS-related costs are comparable with those of other common chronic disorders, including hypertension and asthma. According to the American Heart Association, the estimated total (direct and indirect) annual cost (for the year 2002) of hypertension in the USA will be $47.2 billion.[13] A recent study of patients with IBS and asthma in 20 US managed care plans covering 1.6 million lives showed that the economic burden stemming from diagnostic and treatment-related costs was similar for both conditions. Average total annual charges (medical and pharmacy claims) were $7547 and $7170 per patient per year for subjects with IBS and asthma, respectively.[14]

Several published studies have demonstrated that patients with IBS are more costly to health maintenance organizations and employers than are persons without IBS. In one large community-based study, median annual medical charges (including medical services but excluding outpatient medications) were $742 for patients with IBS versus $429 for controls.[15] A retrospective data analysis of administrative claims from employees of a national US Fortune 100 manufacturer evaluated the economic burden that IBS imposes on employers by comparing direct and indirect costs incurred by patients with IBS with those of matched controls. Results showed that the average total cost (direct and indirect) to the employer per patient with IBS in 1998 was $4527, compared with $3276 for controls, representing a 38% difference. Cost differences were particularly high for ambulatory care services, prescription medications, and missed workdays.[16] A study conducted by Levy et al.[17] evaluated the costs of care for patients with IBS in a health maintenance organization. Results demonstrated that annual total direct costs of care for patients with IBS were 49% higher than for population controls ($4044 vs $2719, respectively).

The objectives of this study are to determine the economic impact of IBS on the Medicaid program and to evaluate the overall health care utilization profile of patients treated for IBS.


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