Abstract
Background
Constipation causes a large number of medical visits each year and imposes significant financial toll on healthcare systems worldwide. So the present community-based study was conducted in order to estimate attributable direct and indirect costs to functional constipation (FC) and to provide an overview of related physician visits in general population of Iran.
Methods
From May 2006 to December 2007, a total of 19,200 adult persons (aged 16 and above) were drawn randomly in Tehran province, Iran (response rate 94%). Participants who reported any gastrointestinal symptoms (2,790 persons) were referred to assigned physicians to be questioned about symptoms of functional bowel disorders according to the Rome III criteria. Direct and indirect costs to FC were calculated. Attributable costs were reported as purchasing power parity dollars (PPP$).
Results
Of the total 18,180 consenting participants in this study, 435 (2.4%) had FC according to Rome III criteria. Mean total cost of constipation per person was 146.84 PPP$, of which 128.68 PPP$ was related to direct costs and 18.16 PPP$ to indirect costs. Higher educated persons (189.75 PPP$), those above 64 years of age (373.42 PPP$), subjects with BMI of less than 18.5 kg/m2 (510.84 PPP$), and widowed persons (258.50 PPP$) had the highest costs.
Conclusions
This study determined that although the economic burden of FC does not seem to be substantial in comparison to other major health problems, it still exacts a substantial toll on the health system for two reasons: chronicity and ambiguity of symptoms.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Talley N (2004) Definitions, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord 4(Suppl 2):S3–S10
Pare P, Ferrazzi S, Thompson W, Irvine E, Rance L (2001) An epidemiological survey of constipation in Canada: definitions, rates, demographics and predictors of health care. Am J Gastroenterol 96:3131–3137
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Functional bowel disorders. Gastroenterology 130:1480–1491
Adibi P, Behzad E, Pirzadeh S, Mohseni M (2007) Bowel habit reference values and abnormalities in young Iranian healthy adults. Dig Dis Sci 52(8):1810–1813
Lembo A, Camilleri M (2003) Chronic constipation. N Engl J Med 349(14):1360–1368
Tedesco F, DiPiro J (1985) Laxative use in constipation. Am J Gastroenterol 80:303–309
Rantis PC Jr, Vernava AM 3rd, Daniel GL, Longo WE (1997) Chronic constipation—is the work-up worth the cost? Dis Colon Rectum 40(3):280–286
Sonnenberg A, Koch T (1989) Physician visits in the United States for constipation: 1958 to 1986. Dig Dis Sci 34:606–611
Johanson J, Sonnenberg A, Koch T (1989) Clinical epidemiology of chronic constipation. J Clin Gastroenterol 11:525–536
Roshandel D, Rezailashkajani M, Shafaee S, Zali MR (2007) A cost analysis of functional bowel disorders in Iran. Int J Colorectal Dis 22(7):791–799
Khoshkrood-Mansoori B, Pourhoseingholi MA, Safaee A, Moghimi-Dehkordi B, Sedigh-Tonekaboni B, Pourhoseingholi A, Habibi M, Zali MR (2009) Irritable bowel syndrome: a population based study. J Gastrointestin Liver Dis 18(4):413–418
Comprehensive database of Iranian physicians. Available from http://www.irteb.com/fee.htm
Database of herbal drugs in Iran. Available from: http://www.irteb.com/herbal/herbaldrugeindex.htm
Comparison table of Rome II & Rome III adult diagnostic criteria. Available from: http://www.romecriteria.org/assets/pdf/20_RomeIII_apB_899–916.pdf
Khoshbaten M, Hekmatdoost A, Ghasemi H, Entezariasl M (2004) Prevalence of gastrointestinal symptoms and signs in northwestern Tabriz, Iran. Indian J Gastroenterol 23(5):168–170
Anastasiou F, Mouzas I, Moschandreas J, Kouroumalis E, Lionis C (2008) Exploring the agreement between diagnostic criteria for IBS in primary care in Greece. BMC Res Notes 1:127
Lederle FA (1995) Epidemiology of constipation in elderly patients. Drug utilisation and cost-containment strategies. Drugs Aging 6(6):465–469
Chang J, Locke G, Schleck C, Zinsmeister A, Talley N (2007) Risk factors for chronic constipation and a possible role of analgesics. Neurogastroenterol Motil 19(11):905–911
Gálvez C, Garrigues V, Ortiz V, Ponce M, Nos P, Ponce J (2006) Healthcare seeking for constipation: a population-based survey in the Mediterranean area of Spain. Aliment Pharmacol Ther 24(2):421–428
Talley N (2008) Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil 20(S1):121–129
Data catalog. The World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20535285~menuPK:1390200~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html
Everhart JE (ed) (2008) The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. US Government Printing Office, Washington, DC
Nyrop K, Palsson O, Levy R, Korff M, Feld A, Turner M et al (2007) Costs of healthcare for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal pain. Aliment Pharmacol Ther 26(2):237–248
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mohaghegh Shalmani, H., Soori, H., Khoshkrood Mansoori, B. et al. Direct and indirect medical costs of functional constipation: a population-based study. Int J Colorectal Dis 26, 515–522 (2011). https://doi.org/10.1007/s00384-010-1077-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-010-1077-4