Schmier Jordana K, Miller Paige E, Levine Jessica A, Perez Vanessa, Maki Kevin C, Rains Tia M, Devareddy Latha, Sanders Lisa M, Alexander Dominik D
Exponent Inc,, 525 W, Monroe Street Suite 1050, Chicago, IL 60661, USA.
BMC Public Health. 2014 Apr 17;14:374. doi: 10.1186/1471-2458-14-374.
Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation.
Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose-response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter.
The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion.
Increasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes.
近5%的美国人患有功能性便秘，其中许多人可能会从增加膳食纤维摄入量中受益。与增加摄入量相关的每年便秘相关医疗保健成本节省可能相当可观，但此前尚未进行过研究。本研究的目的是评估增加膳食纤维摄入量对便秘相关直接医疗成本的经济影响。
进行文献检索，以确定美国人群具有全国代表性的输入参数，包括功能性便秘的患病率；当前膳食纤维摄入量；达到推荐摄入量的人群比例；以及预计因膳食纤维摄入量变化而在便秘缓解方面有反应的百分比。对已发表数据进行剂量反应分析，以估计膳食纤维摄入量每增加1克/天，便秘患病率降低的百分比。便秘的年度直接医疗成本来自文献，并更新为2012年的美元价值。敏感性分析探讨了对成人与儿童人群的影响以及模型对每个输入参数的稳健性。
基础案例中，成年人每年直接医疗成本节省为127亿美元。基础案例假设目前3%的男性和6%的女性达到推荐的膳食纤维摄入量；膳食纤维摄入量每增加1克/天，便秘患病率将降低1.9%；所有成年人将其膳食纤维摄入量增加到推荐水平（平均增加9克/天）。探索多种替代方案的敏感性分析发现，即使只有50%的成年人群将膳食纤维摄入量增加3克/天，每年节省的医疗成本也超过20亿美元。所有合理的情景都导致至少10亿美元的成本节省。
增加膳食纤维摄入量可带来可观的成本节省，可能超过120亿美元，鉴于模型中排除了生产力损失成本，这是一个保守估计。通过简单、现实的饮食习惯改变可避免127亿美元便秘直接医疗成本的这一发现很有前景，并凸显了增加膳食纤维摄入量策略的必要性。
