Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, with an estimated prevalence rate in the general population of 10–15% in industrialised countries. Although IBS is not a life-threatening disease, it contributes significantly to a large segment of healthcare resource consumption. This review provides an overview of studies addressing the direct and indirect costs of IBS in the US and the UK. A systematic literature search was conducted in MEDLINE and the Cochrane library; additionally, all reference lists covering the years from 1960 to May 2004 were scanned.
Twenty-four publications for the US and the UK, published between 1991 and 2003, were identified: 6 were excluded, 18 were included. Data for the UK, US and UK + US were reported in 5, 11 and 2 publications, respectively. Total direct cost estimates per patient per year ranged from $US348 to $US8750 (calculated for year 2002). The average number of days off work per year because of IBS was between 8.5 and 21.6; indirect costs ranged from $US355 to $US3344.
The total costs and cost components of IBS are influenced by several factors: features of the investigated patient group (age, limitation to healthcare seekers or all IBS patients, comorbidity, severity of symptoms), database used, method of data collection (retrospective or prospective, varying cost components, time-point of data collection in relation to index-date of IBS diagnosis, method of cost calculation [incidence or prevalence based]) and different healthcare systems in the US and the UK. These factors led to the incomparability of published data, thus no comprehensive picture can be drawn of the total costs related to IBS in the UK and US. Data underline the magnitude of the economic impact of IBS in the UK and US, which is increased by a factor of 1.1–6.0, compared with matched non-IBS control groups.
IBS contributes both direct and indirect costs to the total healthcare bill. Further studies should take influencial factors into account and report related data carefully in order to provide useful and comparable published cost data. Additionally, further research on the cost effectiveness of diagnostic procedures and therapies in IBS is required to define strategies to help IBS patients improve their quality of life and reduce related costs.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
The preparation of this review was supported by an unrestricted grant by Altana Pharma AG, Konstanz, Germany. The authors have no conflicts of interest that are directly relevant to the content of this review.
Osterberg E, Blomquist L, Krakau I, et al. A population study on irritable bowel syndrome and mental health. Scand J Gastroenterol 2000; 35 (3): 264–8PubMedCrossRefGoogle Scholar
Talley NJ, O’Keefe EA, Zinsmeister AR, et al. Prevalence of gastrointestinal symptoms in the elderly: a population-based study. Gastroenterology 1992; 102 (3): 895–901PubMedGoogle Scholar
Saito YA, Locke GR, Talley NJ, et al. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Dig Dis Sci 2000; 95 (10): 2816–24Google Scholar
Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders: prevalence, sociodemography, and health impact 320. Dig Dis Sci 1993; 38 (9): 1569–80PubMedCrossRefGoogle Scholar
Saito YA, Schoenfeld P, Locke GR, et al. The epidemiology of irritable bowel syndrome in North America: a systematic review. Resource utilization associated with irritable bowel syndrome in the United States 1987-1997. Consensus report: clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome. Dig Dis Sci 2002; 97 (8): 1910–5Google Scholar
Talley NJ, Zinsmeister AR, Melton LJ. Irritable bowel syndrome in a community: symptom subgroups, risk factors, and health care utilization. Am J Epidemiol 1995; 142 (1): 76–83PubMedGoogle Scholar
Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 1997; 112 (6): 2120–37PubMedCrossRefGoogle Scholar
Manning AP, Thompson WG, Heaton KW, et al. Towards positive diagnosis of the irritable bowel. BMJ 1978; 2 (6138): 653–4PubMedCrossRefGoogle Scholar
Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Psychother Psychosom Med Psychol 1999; 45 (2): 1134–47Google Scholar
Boyce PM, Koloski NA, Talley NJ. Irritable bowel syndrome according to varying diagnostic criteria: are the new Rome II criteria unnecessarily restrictive for research and practice? Am J Gastroenterol 2000; 95 (11): 3176–83PubMedCrossRefGoogle Scholar
Advisory Committee Meeting on Lonotrex. FDA briefing document (alosteron hydrochloride) 2000 [online]. Available from URL: http://www.fda.gov/ohrms/dockets/ac/04/briefing/ 4040B1.htm [Accessed 2005 Nov 18]Google Scholar
Advisory Committee Meeting on Zelmac. FDA briefing document (tegaserod) 2000 [online]. Available from URL: blip://www.fda.gov/ohrms/dockets/ac/04/briefing/4040BI.htm [Accessed 2005 Nov 18]Google Scholar
Bemkover JD, Field C, Greene EM, et al. The economic burden of irritable bowel syndrome in Canada. Can J Gastroenterol 1999; 13 (A): 89A–96AGoogle Scholar
Camilleri M, Williams DE. Economic burden of irritable bowel syndrome: proposed strategies to control expenditures. Pharmacoeconomics 2000; 17 (4): 331–8PubMedCrossRefGoogle Scholar
Inadomi JM, Fennerty MB, Bjorkman D. Systematic review: the economic impact of irritable bowel syndrome. Aliment Pharmacol Ther 2003; 18: 671–82PubMedCrossRefGoogle Scholar
Kozma C, Barghout V, Slaton T, et al. Office-based physician visits: a comparison of irritable bowel syndrome with other gastrointestinal disorders using national ambulatory medical care survey data. Pract Gastroenterol 2002; 26 (9): 58–68Google Scholar
Fullerton S. Functional digestive disorders (FDD) in the year 2000: economic impact. Eur J Surg Suppl 1998; (582): 62–4PubMedGoogle Scholar
Harris MS. Irritable bowel syndrome: a cost-effective approach for primary care physicians. Postgrad Med 1997; 101 (3): 215–6PubMedCrossRefGoogle Scholar
Levy RL, Whitehead WE, von Korff MR, et al. Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterol 2000; 95 (2): 451–6PubMedCrossRefGoogle Scholar
Ricci JF, Jhingran P, McLaughlin T, et al. Costs of care for irritable bowel syndrome in managed care. J Clin Outcomes Manage 2000; 7 (6): 23–8Google Scholar
Levy RL, Von Korff M, Whitehead WE, et al. Costs of care for irritable bowel syndrome patients in a health maintenance organization. Am J Gastroenterol 2001; 96 (11): 3122–9PubMedCrossRefGoogle Scholar
Patel RP, Petitta A, Fogel R, et al. The economic impact of irritable bowel syndrome in a managed care setting. J Clin Gastroenterol 2002; 35 (1): 14–20PubMedCrossRefGoogle Scholar
Leong SA, Barghout V, Birnbaum HG, et al. The economic consequences of irritable bowel syndrome: an employer perspective. Arch Intern Med 2003; 163 (8): 929–35PubMedCrossRefGoogle Scholar
Longstreth GF, Weilson A, Knight K, et al. Irritable bowel syndrome, health care use, and costs: a US managed care perspective. Am J Gastroenterol 2003; 98 (3): 600–7PubMedCrossRefGoogle Scholar
Akehurst RL, Brazier JE, Mathers N, et al. Health-related quality of life and cost impact of irritable bowel syndrome in a UK primary care setting. Pharmacoeconomics 2002; 20 (7): 455–62PubMedCrossRefGoogle Scholar
Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology 2002; 122: 1500–11PubMedCrossRefGoogle Scholar
Shih YC, Barghout VE, Sandler RS, et al. Resource utilization associated with irritable bowel syndrome in the United States 1987-1997: consensus report. Clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome. Dig Dis Sci 2002; 47 (8): 1705–15PubMedCrossRefGoogle Scholar
Creed F, Fernandez L, Guthrie E, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology 2003; 124 (2): 303–17PubMedCrossRefGoogle Scholar
Hahn BA, Yan S, Strassels S. Impact of irritable bowel syndrome on quality of life and resource use in the United States and United Kingdom. Digestion 1999; 60 (1): 77–81PubMedCrossRefGoogle Scholar
Karampela K, Lacey L, Hahn B, et al. Costs associated with healthcare resource use and productivity loss in patients with irritable bowel syndrome (IBS) [abstract]. Clin Pract 1999; A69: G0293Google Scholar
Ladabaum U. Safety, efficacy and costs of pharmacotherapy for functional gastrointestinal disorders: the case of alosetron and its implications. Aliment Pharmacol Ther 2003; 17 (8): 1021–30PubMedCrossRefGoogle Scholar
Suleiman S, Sonnenberg A. Cost-effectiveness of endoscopy in irritable bowel syndrome. Arch Intern Med 2001; 161 (3): 369–75PubMedCrossRefGoogle Scholar
Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic feature of irritable bowel disease: the effect of hypnotherapy. Aliment Pharmacol Ther 1996; 10 (1): 91–5PubMedCrossRefGoogle Scholar
Creed F, Ratcliffe J, Fernandez L, et al. Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome. Ann Intern Med 2001; 134 (9 Pt 2): 860–80PubMedGoogle Scholar
Hahn B, Watson M, Yan S, et al. Irritable bowel syndrome symptom patterns: frequency, duration, and severity. Dig Dis Sci 1998; 43 (12): 2715–8PubMedCrossRefGoogle Scholar
Heaton KW, O’Donnell LJ, Braddon FE, et al. Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology 1992; 102 (6): 1962–7PubMedGoogle Scholar
Talley NJ. Irritable bowel syndrome: definition, diagnosis and epidemiology. Baillieres Best Pract Res Clin Gastroenterol 1999; 13 (3): 371–84PubMedCrossRefGoogle Scholar
Luscombe FA. Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: a review. Qual Life Res 2000; 9 (2): 161–76PubMedCrossRefGoogle Scholar