Irritable bowel syndrome, health care use, and costs: a U.S. managed care perspective

• Published in: The American journal of gastroenterology Vol. 98; no. 3; pp. 600 - 607
• Main Authors: Longstreth, George F, Wilson, Alisa, Knight, Kevin, Wong, John, Chiou, Chiun-Fang, Barghout, Victoria, Frech, Feride, Ofman, Joshua J
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Inc 01-03-2003; Blackwell Publishing
• Subjects: Adult; Aged; Ambulatory Care - economics; Ambulatory Care - utilization; Biological and medical sciences; Colonic Diseases, Functional - diagnosis; Colonic Diseases, Functional - economics; Drug Utilization - economics; Drug Utilization - statistics & numerical data; Female; Gastroenterology. Liver. Pancreas. Abdomen; Health Care Costs - statistics & numerical data; Health Resources - utilization; Humans; Male; Managed Care Programs - economics; Managed Care Programs - utilization; Medical sciences; Middle Aged; Odds Ratio; Other diseases. Semiology; Severity of Illness Index; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; United States; United States; Human; Symptomatology; Costs; Pain; Evaluation scale; Irritable bowel syndrome; Therapeutical request; Digestive diseases; Intestinal disease; Predictive factor; Statistical study; Public health
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1016/S0002-9270(02)06018-5

We performed an evaluation of patient symptoms, health care use, and costs to define the burden of illness of irritable bowel syndrome (IBS) and the relation to the severity of abdominal pain/discomfort in a large health maintenance organization.
All 6500 adult health maintenance organization members who had undergone flexible sigmoidoscopy in the year 2000 were mailed a questionnaire that elicited Rome I symptom criteria and severity ratings for abdominal pain/discomfort. Multiple health care use measures were obtained from various administrative databases. IBS patients were compared with a control group of non-IBS subjects, and analyses were adjusted for age and sex.
We received 2613 (40.2%) responses. Compared with non-IBS subjects over 2 yr, IBS patients had more outpatient visits (medical, surgery, and emergency,
p < 0.05), were hospitalized more often (
p < 0.05), and had more total outpatient prescriptions (
p < 0.05) and IBS-related prescriptions (
p < 0.05). Over 1 yr, total costs were 51% higher in IBS patients, who also had higher costs for outpatient visits, drugs, and radiology and laboratory tests (
p < 0.05). Total costs were increased by 35%, 52%, and 59% in IBS patients with mild, moderate, and severe symptoms of abdominal pain/discomfort compared with non-IBS subjects (
p < 0.05).
Using Rome I symptom criteria, we found that IBS is associated with a broad pattern of increased health care use and costs. The severity of abdominal pain/discomfort is a significant predictor of health care use and costs for patients with IBS compared with non-IBS subjects.