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Cost-Effectiveness of Linaclotide Compared to Osmotic Laxatives in the Treatment of Irritable Bowel Syndrome with Constipation in China

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A Correction to this article was published on 28 July 2022

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Linaclotide, a selective agonist of guanylate cyclase C, was highly recommended for the treatment of irritable bowel syndrome with constipation (IBS-C). However, the cost-effectiveness of linaclotide in Chinese is not known, and this study aimed to assess the cost-effectiveness of linaclotide for patients with IBS-C.


An economic evaluation was conducted with a Markov model from a societal perspective. The Markov model was structured to simulate the discontinuation and continuation of medication in IBS-C patients in clinical practice, as well as the revisit and non-visit of non-responding patients. The cycle of the model was 4 weeks, and the time horizon was 1 year. The efficacy data in the model was from the risk ratios obtained by the meta-analysis and the calculation of the response rate of the three medications. The utility, discontinuation rate of the medication, and revisit rate data were from published literature, while the cost data were obtained from experts’ opinions and published literature. A series of sensitivity analyses was performed on parameters potentially having impact on the model outputs.


The QALYs (quality-adjusted life years) gained for 1-year treatment with linaclotide, polyethylene glycol, and lactulose were 0.821, 0.795, and 0.781, respectively. The corresponding total costs were CNY 7,721 (USD 1,120), CNY 8,797 (USD 1,276) and CNY 9,481 (USD 1,375). In both comparisons, linaclotide was dominant. Compared with polyethylene glycol and lactulose, the likelihood of linaclotide being cost-effective was 100% for both, using 1 times per capita GDP per QALY as willingness-to-pay threshold.


IBS-C seriously affects the quality of life of patients with IBS-C, and linaclotide can improve symptoms and quality of life at less cost.

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This work was supported by AstraZeneca Pharmaceutical Co Ltd. The journal’s Rapid Service Fee was funded by the authors.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

All authors contributed to the study conception and design. Prof. Xuan and Prof. Chen was responsible for the conception and design of the study. Prof. Xuan was responsible for obtaining funding. Mr. Xiao was responsible for the analysis and interpretation of the data. Mrs. Yue and Mrs. Chen was responsible for the collection and assembly of data, as well as the writing of the manuscript. The manuscript has been read and approved by all the authors, that all journal requirements for authorship have been met, and that each author believes that the manuscript represents honest work.


Dunming Xiao, Yue Zhang, Wanxin Chen, Jianwei Xuan and Yingyao Chen all have nothing to disclose. The funding agencies had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Data availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Correspondence to Jianwei Xuan or Yingyao Chen.

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Xiao, D., Zhang, Y., Chen, W. et al. Cost-Effectiveness of Linaclotide Compared to Osmotic Laxatives in the Treatment of Irritable Bowel Syndrome with Constipation in China. Adv Ther 39, 2971–2983 (2022).

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