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

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

Disclosures

Curr Med Res Opin. 2003;19(8) 

In This Article

Limitations

Because this study included only patients with diagnosed IBS, we may be overstating the net economic impact of IBS; those who seek treatment and obtain a diagnosis (consulters) may have more severe symptoms than others who self-treat their IBS. Alternatively, however, consulters may represent patients who are frustrated at the lack of efficacy of available agents and frequently visit physicians in search of relief. To decrease reliance on a single criterion for IBS diagnosis, we conducted a sensitivity analysis using alternative definitions and found similar incremental expenditures.

Another limitation of this analysis is uncertainty about how much of the difference in expenditures between IBS cases and matched controls can be assigned to IBS alone. Because this study matched important demographic variables and used Medicare eligibility and measures of comorbidity in a regression model, our net adjusted incremental expenditure results control for these potential confounders. To the extent that unobserved confounders may be inherent in our comparisons, the net incremental expenditures that we attribute to IBS are limited. Additionally, the expenditures captured in this study may be underestimated because they do not include use of the recently available serotonin modulators, over-the-counter products, or alternative medicine remedies, nor do they include the costs that Medicare paid for dually eligible recipients. Finally, experience suggests that findings from this current study should be applied cautiously to Medicaid programs in other states.

Because the patient identification methodology used for the sensitivity analysis did not include patients diagnosed with functional diarrhea or abdominal pain and diarrhea, the estimated prevalence and total expenditures of IBS of probable patients in this study may be underestimated. It is possible that patients diagnosed with functional diarrhea and not with IBS may in fact have IBS, and these recipient's expenditures were not captured in the sensitivity analysis of this study.

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