Abstract
Background
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.
Objective
We undertook this systematic review to comprehensively evaluate the cost effectiveness of treatments for CC.
Methods
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.
Results
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.
Conclusions
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.
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References
Lindberg G, Hamid S, Malfertheiner P, Thomsen O, Fernandez L, Garisch J, et al. World gastroenterology organisation global guideline. J Clin Gastroenterol. 2011;45:483–7.
Crowell MD, Harris LA, Lunsford TNDJ. Emerging drugs for chronic constipation. Expert Opin Emerg Drugs. 2009;14:493–504.
Gonzalez-Martinez MA, Ortiz-Olvera NX, Mendez-Navarro J. Novel pharmacological therapies for management of chronic constipation. J Clin Gastroenterol. 2014;48:21–8.
Faigel DO. A clinical approach to constipation. Clin Cornerstone. 2002;4:11–21.
Dennison C, Prasad M, Lloyd A, Bhattacharyya SK, Dhawan R, Coyne K. The health-related quality of life and economic burden of constipation. Pharmacoeconomics. 2005;23:461–76.
Dik VK, Siersema PD, Joseph A, Hodgkins P, Smeets HM, van Oijen MGH. Constipation-related direct medical costs in 16,887 patients newly diagnosed with chronic constipation. Eur J Gastroenterol Hepatol. 2014;26:1260–6.
Johanson JF. Review of the treatment options for chronic constipation. Med Gen Med. 2007;9:25.
Bharucha AE, Dorn SD, Lembo A, Pressman A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144:211–7.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.
Evers S, Goossens M, de Vet H, van Tulder M, Ament A. Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int J Technol Assess Health Care. 2005;21:240–5.
Taylor RR, Guest JF. Clinical trial: cost-effectiveness of macrogol 3350 compared to lactulose in the treatment of adults suffering from chronic constipation in the UK. Aliment Pharmacol Ther. 2009;31:302–12.
Nuijten MJC, Dubois DJ, Joseph A, Annemans L. Cost-effectiveness of prucalopride in the treatment of chronic constipation in the Netherlands. Front Pharmacol. 2015;6:67.
Passmore AP, Wilson-Davies K, Stoker C, Scott ME. Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. BMJ. 1993;307:769–71.
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.
Huang H, Taylor DCA, Carson RT, Sarocco P, Friedman M, Munsell M, et al. Economic evaluation of linaclotide for the treatment of adult patients with chronic idiopathic constipation in the United States. Manag Care. 2016;25:41–8.
Guest JF, Clegg JP, Helter MT. Cost-effectiveness of macrogol 4000 compared to lactulose in the treatment of chronic functional constipation in the UK. Curr Med Res Opin. 2008;24:1841–52.
Christie AH, Culbert P, Guest JF. Economic impact of low dose polyethylene glycol 3350 plus electrolytes compared with lactulose in the management of idiopathic constipation in the UK. Pharmacoeconomics. 2002;20:49–60.
Bub S, Brinckmann J, Cicconetti G, Valentine B. Efficacy of an herbal dietary supplement (Smooth Move) in the management of constipation in nursing home residents: a randomized, double-blind, placebo-controlled study. J Am Med Dir Assoc. 2006;7:556–61.
Lämås K, Lindholm L, Engström B, Jacobsson C. Abdominal massage for people with constipation: a cost utility analysis. J Adv Nurs. 2010;66:1719–29.
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.
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(Suppl 2):II43–7.
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.
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.
Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses. JAMA. 2016;316:1093.
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.
Fleurence RL, Spackman DE, Hollenbeak C. Does the funding source influence the results in economic evaluations? Pharmacoeconomics. 2010;28:295–306.
Asaria M, Griffin S, Cookson R. Distributional cost-effectiveness analysis. Med Decis Mak. 2016;36:8–19.
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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.
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Dolly Han, Nicolas Iragorri, Fiona Clement, Diane Lorenzetti and Eldon Spackman report no conflicts of interest.
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Han, D., Iragorri, N., Clement, F. et al. Cost Effectiveness of Treatments for Chronic Constipation: A Systematic Review. PharmacoEconomics 36, 435–449 (2018). https://doi.org/10.1007/s40273-018-0609-6
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DOI: https://doi.org/10.1007/s40273-018-0609-6