1 Allergan, Jersey City, New Jersey.
2 Axtria, Berkeley Heights, New Jersey.
J Manag Care Spec Pharm. 2017 Apr;23(4):453-460. doi: 10.18553/jmcp.2016.16138. Epub 2016 Nov 21.
The economic burden associated with irritable bowel syndrome with diarrhea (IBS-D) is not well understood.
To (a) evaluate total annual all-cause, gastrointestinal (GI)-related, and symptom-related (i.e., IBS, diarrhea, abdominal pain) health care resource use and costs among IBS-D patients in a U.S. commercially insured population and (b) estimate incremental all-cause health care costs of IBS-D patients versus matched controls.
Patients aged ≥ 18 years with 12 months of continuous medical and pharmacy benefit eligibility in 2013 were identified from the Truven Health MarketScan research database. The study sample included patients with ≥ 1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code in any position for IBS (ICD-9-CM 564.1x) and either (a) ≥ 2 claims for diarrhea (ICD-9-CM 787.91, 564.5x) on different service dates in 2013, or (b) ≥ 1 claim for diarrhea plus ≥ 1 claim for abdominal pain (ICD-9-CM 789.0x) on different service dates in 2013, or (c) ≥ 1 claim for diarrhea plus ≥ 1 pharmacy claim for a symptom-related prescription on different service dates in 2013. Controls included patients with no claims for IBS, diarrhea, abdominal pain, or symptom-related prescriptions in 2013. Controls were randomly selected and matched with IBS-D patients in a 1:1 ratio based on age (± 4 years), gender, geographic location, and health plan type. All-cause health care resource utilization included medical and pharmacy claims for health care services associated with any condition. Total health care costs were defined as the sum of health plan-paid and patient-paid direct health care costs from prescriptions and medical services, including inpatient, emergency department (ED), and physician office visits, and other outpatient services. A total cost approach was used to assess all-cause, GI-related, and symptom-related health care costs for IBS-D patients. An incremental cost approach via generalized linear models was used to assess the excess all-cause costs attributable to IBS-D after adjusting for demographics and general and GI comorbidities.
Of 39,306 patients (n = 19,653 each for IBS-D and matched controls) included, mean (± SD) age was 47 (± 17) years and 76.5% were female. Compared with controls, IBS-D patients had a significantly higher mean annual number of hospitalizations, ED visits, office visits, and monthly (30-day) prescription fills. Mean annual all-cause health care costs for IBS-D patients were $13,038, with over half (58.4%) attributable to office visits and other outpatient services (e.g., diagnostic tests and laboratory or radiology services), and remaining costs attributable to prescriptions (19.5%), inpatient admissions (13.6%), and ED visits (8.5%). GI-related ($3,817) and symptom-related ($1,693) costs were also primarily driven by other outpatient service costs. After adjusting for demographics and comorbidities, incremental annual all-cause costs associated with IBS-D were $2,268 ($9,436 for IBS-D patients vs. $7,169 for matched controls; P < 0.001) per patient/year, of which 78% were from medical costs and 22% were from prescription costs.
IBS-D was associated with a substantial burden in direct costs in this population. Compared with matched controls, IBS-D patients had greater medical service use and incurred significantly more annual all-cause health care costs, even after controlling for demographics and comorbidities. Incremental costs associated with IBS-D were primarily attributable to increased use of medical services rather than pharmacy costs.
This study was funded by Allergan. The authors received no compensation related to the development of the manuscript. Buono and Andrae are employees of Allergan. Mathur is an employee of Axtria. Averitt was an employee of Axtria at the time this study was conducted. Data from this manuscript have previously been presented in poster format by Buono at the American College of Gastroenterology Annual Scientific Meeting; Honolulu, Hawaii; October 16-21, 2015. Mathur and Averitt were involved in conducting the study analyses. All authors were involved in the study design, interpretation of the data, and preparation of the manuscript. The authors take full responsibility for the scope, direction, and content of the manuscript and have approved the submitted manuscript.
与腹泻型肠易激综合征（IBS-D）相关的经济负担尚未被充分了解。
（a）评估美国商业保险人群中 IBS-D 患者的全因、胃肠道（GI）相关和症状相关（即 IBS、腹泻、腹痛）医疗保健资源利用和成本，以及（b）估计 IBS-D 患者与匹配对照者相比的全因医疗保健成本增量。
从 Truven Health MarketScan 研究数据库中确定了在 2013 年有 12 个月连续医疗和药房福利资格的年龄≥18 岁的患者。研究样本包括在 2013 年的任何位置均有≥1 项与 IBS 相关的 ICD-9-CM 诊断代码（ICD-9-CM 564.1x）的医疗索赔，且（a）2013 年有≥2 次不同服务日期的腹泻（ICD-9-CM 787.91、564.5x）的索赔，或（b）2013 年有≥1 次腹泻和≥1 次腹痛（ICD-9-CM 789.0x）的索赔，或（c）2013 年有≥1 次腹泻和≥1 次不同服务日期的症状相关处方的药房索赔。对照者包括在 2013 年无 IBS、腹泻、腹痛或症状相关处方的患者。对照者是根据年龄（±4 岁）、性别、地理位置和健康计划类型，与 IBS-D 患者以 1:1 的比例随机选择并匹配的。全因医疗保健资源利用包括与任何疾病相关的医疗和药房保健服务的索赔。总医疗保健费用定义为来自处方和医疗服务的健康计划支付和患者自付的直接医疗保健费用，包括住院、急诊部（ED）和医生办公室就诊以及其他门诊服务。采用总费用方法评估 IBS-D 患者的全因、GI 相关和症状相关医疗保健费用。采用广义线性模型的增量成本方法，在调整人口统计学、一般和 GI 合并症后，评估 IBS-D 导致的全因成本增量。
在 39306 例患者中（n=19653 例，每组各有 IBS-D 和匹配的对照者），平均（±SD）年龄为 47（±17）岁，76.5%为女性。与对照者相比，IBS-D 患者的年平均住院次数、ED 就诊次数、医生办公室就诊次数和每月（30 天）处方配药次数均较高。IBS-D 患者的年平均全因医疗保健费用为 13038 美元，其中超过一半（58.4%）归因于医生办公室就诊和其他门诊服务（如诊断性检查和实验室或放射学服务），其余费用归因于处方（19.5%）、住院治疗（13.6%）和 ED 就诊（8.5%）。GI 相关（3817 美元）和症状相关（1693 美元）费用也主要由其他门诊服务费用驱动。调整人口统计学和合并症后，IBS-D 相关的年全因增量成本为 2268 美元（IBS-D 患者每年 9436 美元，匹配对照者每年 7169 美元；P<0.001），其中 78%来自医疗费用，22%来自处方费用。
在该人群中，IBS-D 与直接成本的大量负担相关。与匹配的对照者相比，IBS-D 患者的医疗服务利用率更高，且发生全因医疗保健费用的年增量显著更高，即使在控制人口统计学和合并症后也是如此。IBS-D 相关的增量成本主要归因于医疗服务使用的增加，而不是处方费用。
本研究由 Allergan 资助。作者与手稿的开发没有任何报酬关系。Buono 和 Andrae 是 Allergan 的员工。Mathur 是 Axtria 的员工。Averitt 在进行本研究时是 Axtria 的员工。本文数据以前曾由 Buono 在 2015 年 10 月 16 日至 21 日在美国胃肠病学会年会上以海报形式展示过；檀香山，夏威夷州。Mathur 和 Averitt 参与了研究分析。所有作者均参与了研究设计、数据解释和稿件准备。作者对稿件的范围、方向和内容承担全部责任，并已批准提交的稿件。
