Article

The economic consequences of irritable bowel syndrome - A US employer perspective

Analysis Group/Economics, Boston, MA 02199, USA.
Archives of Internal Medicine (Impact Factor: 13.25). 04/2003; 163(8):929-35. DOI: 10.1001/archinte.163.8.929
Source: PubMed

ABSTRACT The objective of this study was to measure the direct costs of treating irritable bowel syndrome (IBS) and the indirect costs in the workplace. This was accomplished through retrospective analysis of administrative claims data from a national Fortune 100 manufacturer, which includes all medical, pharmaceutical, and disability claims for the company's employees, spouses/dependents, and retirees.
Patients with IBS were identified as individuals, aged 18 to 64 years, who received a primary code for IBS or a secondary code for IBS and a primary code for constipation or abdominal pain between January 1, 1996, and December 31, 1998. Of these patients with IBS, 93.7% were matched based on age, sex, employment status, and ZIP code to a control population of beneficiaries. Direct and indirect costs for patients with IBS were compared with those of matched controls.
The average total cost (direct plus indirect) per patient with IBS was 4527 dollars in 1998 compared with 3276 dollars for a control beneficiary (P<.001). The average physician visit costs were 524 dollars and 345 dollars for patients with IBS and controls, respectively (P<.001). The average outpatient care costs to the employer were 1258 dollars and 742 dollars for patients with IBS and controls, respectively (P<.001). Medically related work absenteeism cost the employer 901 dollars on average per employee treated for IBS compared with 528 dollars on average per employee without IBS (P<.001).
Irritable bowel syndrome is a significant financial burden on the employer that arises from an increase in direct and indirect costs compared with the control group.

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    ABSTRACT: Irritable bowel syndrome (IBS) is a common gut problem that interferes with many people's enjoyment of life. It is a chronic fluctuating condition with features that include recurrent abdominal pain with altered bowel habit and no detectable structural abnormality. Conditions such as coeliac disease and frustose intolerance, for example, must be excluded. There is marked variation in how people experience what is termed 'IBS': IBS with constipation dominating is known as 'IBS-C'; if diarrhoea is most prominent it is termed 'IBS-D'; and alternating bowel habit is known as 'IBS-A'. 1
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    ABSTRACT: Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder characterised by abdominal pain and abnormal bowel function. It is associated with a high rate of healthcare consumption and significant health care costs. The prevalence and economic burden of IBS in Finland has not been studied before. The aims of this study were to assess the prevalence of IBS according to various diagnostic criteria and to study the rates of psychiatric and somatic comorbidity in IBS. In addition, health care consumption and societal costs of IBS were to be evaluated. Methods: The study was a two-phase postal survey. Questionnaire I identifying IBS by Manning 2 (at least two of the six Manning symptoms), Manning 3 (at least three Manning symptoms), Rome I, and Rome II criteria, was mailed to a random sample of 5 000 working age subjects. It also covered extra-GI symptoms such as headache, back pain, and depression. Questionnaire II, covering rates of physician visits, and use of GI medication, was sent to subjects fulfilling Manning 2 or Rome II IBS criteria in Questionnaire I. Results: The response rate was 73% and 86% for questionnaires I and II. The prevalence of IBS was 15.9%, 9.6%, 5.6%, and 5.1% according to Manning 2, Manning 3, Rome I, and Rome II criteria. Of those meeting Rome II criteria, 97% also met Manning 2 criteria. Presence of severe abdominal pain was more often reported by subjects meeting either of the Rome criteria than those meeting either of the Manning criteria. Presence of depression, anxiety, and several somatic symptoms was more common among subjects meeting any IBS criterion than by controls. Of subjects with depressive symptoms, 11.6% met Rome II IBS criteria compared to 3.7% of those with no depressiveness. Subjects meeting any IBS criteria made more physician visits than controls. Intensity of GI symptoms and presence of dyspeptic symptoms were the strongest predictors of GI consultations. Presence of dyspeptic symptoms and a history of abdominal pain in childhood also predicted non-GI visits. Annual GI related individual costs were higher in the Rome II group (497 ) than in the Manning 2 group (295 ). Direct expenses of GI symptoms and non GI physician visits ranged between 98M for Rome II and 230M for Manning 2 criteria. Conclusions: The prevalence of IBS varies substantially depending on the criteria applied. Rome II criteria are more restrictive than Manning 2, and they identify an IBS population with more severe GI symptoms, more frequent health care use, and higher individual health care costs. Subjects with IBS demonstrate high rates of psychiatric and somatic comorbidity regardless of health care seeking status. Perceived symptom severity rather than psychiatric comorbidity predicts health care seeking for GI symptoms. IBS incurs considerable medical costs. The direct GI and non-GI costs are equivalent to up to 5% of outpatient health care and medicine costs in Finland. A more integral approach to IBS by physicians, accounting also for comorbid conditions, may produce a more favourable course in IBS patients and reduce health care expenditures. Ärtyvän suolen oireyhtymä (irritable bowel syndrome, IBS) on yleinen vatsavaiva, jonka oireita ovat vatsakivut ja häiriintynyt suolen toiminta, kuten ripuli tai ummetus. Oireiden takana ei ole todettavaa elimellistä sairautta, ja ne pahenevat usein mm. henkisen stressin aikana. Oireyhtymästä onkin käytetty myös nimeä stressivatsa . IBS:n diagnoosi perustuu oirekriteerien täyttymiseen. Aiemmissa tutkimuksissa sen esiintyvyys väestössä on vaihdellut 3%:n ja 25%:n välillä. Laaja vaihtelu selittyy osin IBS-määritelmien ja diagnostisten kriteerien eroista. IBS:n esiintyvyydestä Suomessa ei ole aiempaa tutkimustietoa. Väitöskirjatutkimuksessa selvitettiin IBS:n yleisyyttä Suomessa sekä masentuneisuuden, ahdistuneisuuden ja erilaisten ruumiillisten oireiden esiintymistä IBS:n yhteydessä. Lisäksi tutkittiin terveyspalveluiden käyttöä ja IBS:n terveystaloudellisia kustannuksia. Tutkimus suoritettiin kaksivaiheisena postikyselynä. Ensin lähetettiin 5000:lle väestörekisteristä sattumanvaraisesti poimitulle 18-64 vuotiaalle suomalaiselle kyselykaavake, jonka avulla tunnistettiin IBS-oireiset neljän eri kriteeristön mukaan (Manning 2, Manning 3, Rooma I, Rooma II). Masentuneisuutta ja ahdistuneisuutta mitattiin Raitasalo-Beck-mielialakyselyllä. Tutkimuksen toisessa vaiheessa lähetettiin terveyspalveluiden ja lääkkeiden käyttöä selvittävä kyselykaavake henkilöille, jotka täyttivät Manning 2 tai Rooma II kriteerin. Ensimmäisen vaiheen kyselykaavakkeen palautusprosentti oli 73% ja toisen vaiheen 86%. IBS:n esiintyvyys väestössä vaihteli 5%:n (Rooma II) ja 16%:n (Manning 2) välillä. IBS-oireisilla oli enemmän masentuneisuutta, ahdistuneisuutta ja erilaisia ruumiillisia oireita, kuten päänsärkyä ja selkäkipua, kuin kontrollihenkilöillä, jotka eivät täyttäneet IBS kriteeriä. He käyttivät myös kontrolleja enemmän terveydenhuoltopalveluita sekä vatsavaivojen että muiden vaivojen vuoksi. Rooma II kriteerit täyttävillä oli vaikeammat vatsaoireet ja suuremmat vatsavaivoihin liittyvät terveystaloudelliset kustannukset kuin Manning 2 kriteerit täyttävillä (497 /hlö vs. 295 /hlö). Vatsaoireen vaikeus ennusti terveyspalveluiden käyttöä vahvemmin kuin psyykkiset oireet. Tutkimuksen mukaan IBS on Suomessa yhtä yleinen kuin muissakin länsimaissa. Siihen liittyvät vatsavaivat ja muut oireet aiheuttavat huomattavia terveystaloudellisia kustannuksia: suorat kustannukset ovat jopa 5% avohoitoon ja lääkkeisiin liittyvistä vuotuisista terveydenhuoltomenoista Suomessa.
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    ABSTRACT: Metabolic syndrome is a cluster of five risk factors which have been shown to be associated with increased odds of developing certain medical conditions such as heart disease and diabetes. However, changing definitions of metabolic syndrome in the past have made it difficult to assess the true prevalence of this condition and previous research has been conducted in patient populations or in nationally representative studies. The purpose of this dissertation is to determine the prevalence and impact of metabolic syndrome risk factors and the syndrome itself in a specific employed population to compare with nationally representative samples and to assess prospectively whether metabolic syndrome is a predictor of disease. Since employers in the U.S. are common payers of heatlh care costs, they have an interest in whether or not metabolic syndrome is prevalent among working individuals. Results found that the prevalence of metabolic syndrome in a manufacturing corporation was similar to that found in nationally representative studies. Furthermore, individuals with metabolic syndrome were found to have higher health care costs, pharmaceutical costs, short-term disability absences, and on-the-job productivity losses compared to employees without metabolic syndrome. Finally, metabolic syndrome was a significant predictor of diabetes and heart disease in employees after two years of follow-up, after controlling for age, gender and ethnicity. Metabolic syndrome is an issue for corporations and organizations concerned with rising health care costs and productivity losses. Employees should be offered opportunities to learn of their risk factors as well as ways in which to maintain their good health or improve their health risks. Ph.D. Kinesiology University of Michigan, Horace H. Rackham School of Graduate Studies http://deepblue.lib.umich.edu/bitstream/2027.42/62363/1/abelaire_1.pdf
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