Cost Effectiveness of Treatments for Chronic Constipation: A Systematic Review
- 621 Downloads
Chronic constipation (CC) has a significant impact on patients’ quality of life and imposes an economic burden on individuals and the healthcare system. Treatment options include dietary changes, lifestyle modifications, fibre supplements, stool softeners, and laxatives.
We undertook this systematic review to comprehensively evaluate the cost effectiveness of treatments for CC.
We searched ten common databases to identify economic evaluations published to 13 June 2017. Abstract and full-text review were completed in duplicate. The quality of the included studies was assessed using the Consensus on Health Economic Criteria. Data extracted included costs and outcomes of treatments for CC and cost-effectiveness methods. A narrative synthesis was completed.
From the 4338 unique citations identified, 79 proceeded to full-text review, with 10 studies forming the final dataset. Eight different definitions of CC were used to define the study populations. Study designs used were decision-tree models (4), Markov model (1), and retrospective (1) and prospective (4) studies. Quality-adjusted life-years (QALY) were reported in five studies; other outcomes included, discontinuation of laxative treatment and frequency of bowel movements. The majority of studies stated that their results were from a payer perspective; however, some of these studies only considered treatment costs, a subset of costs included in the payer perspective. Lifestyle advice, dietary treatments and abdominal massage were each compared with current care with laxatives, while polyethylene glycol (PEG) and senna–fibre combination were each compared with lactulose. Two studies compared newer treatments in patients who had not responded to laxatives: prucalopride was compared with continuing laxatives, and linaclotide was compared with lubiprostone. All of the interventions were reported by the study authors to be cost effective, with the exception of abdominal massage.
A consistent definition of CC is needed and the QALY should be used to capture the diverse symptoms of CC. Further analysis is needed comparing all available treatments for patients who have not responded to laxatives. Overall, results from economic evaluations appear to align with stepwise practice guidelines.
DH, FC, DL and ES designed the search strategy and study protocol. DH and NI reviewed all abstracts and papers, were responsible for the data abstraction, undertook the quality assessment and prepared the figures and tables. DH and ES drafted the manuscript, and all authors reviewed and approved the final version for publication.
Compliance with Ethical Standards
Conflict of interest
Dolly Han, Nicolas Iragorri, Fiona Clement, Diane Lorenzetti and Eldon Spackman report no conflicts of interest.
- 7.Johanson JF. Review of the treatment options for chronic constipation. Med Gen Med. 2007;9:25.Google Scholar
- 14.Speed C, Heaven B, Adamson A, Bond J, Corbett S, Lake A, et al. LIFELAX—diet and LIFEstyle versus LAXatives in the management of chronic constipation in older people: randomised controlled trial. Health Technol Assess (Rockv). 2010;14:1–251.Google Scholar
- 20.Migeon-Duballet I, Chabin M, Gautier A, Mistouflet T, Bonnet M, Aubert JM, et al. Long-term efficacy and cost-effectiveness of polyethylene glycol 3350 plus electrolytes in chronic constipation: a retrospective study in a disabled population. Curr Med Res Opin. 2006;22:1227–35.CrossRefGoogle Scholar
- 22.National Institute for Health and Care Excellence. Guide to the methods of technology appraisal 2013 | Guidance and guidelines. London: National Institute for Health and Care Excellence; 2013.Google Scholar
- 23.Drummond M, Sculpher M, Claxton K, Stoddard G, Torrance GW. Methods for the economic evaluation of health care programmes. 4th ed. Oxford: Oxford University Press; 2015.Google Scholar
- 25.Guidelines for the economic evaluation of health technologies: Canada. Canadian Agency for Drugs and Technologies in Health. https://www.cadth.ca/about-cadth/how-we-do-it/methods-and-guidelines/guidelines-for-the-economic-evaluation-of-health-technologies-canada. Accessed 14 Nov 2017.