Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York.
Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Clin Gastroenterol Hepatol. 2021 Jan;19(1):80-86. doi: 10.1016/j.cgh.2020.04.003. Epub 2020 Apr 11.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a common chronic functional bowel disorder for which patients take significant risks to ameliorate symptoms. Unfortunately, there is no cure for IBS. We assessed the willingness of patients with IBS to take medication risks and the costs they would pay to improve symptoms.
We mailed a survey on medication risk to patients with IBS who met the Rome IV criteria. The survey collected data on patient demographics, symptoms, medication use, prior medication-averse events, and pain catastrophization. A standard gamble evaluated respondents' willingness to take medication risks, and a willingness-to-pay set of questions quantified maximal spending on a hypothetical medication to treat IBS.
Among respondents (n = 215; 81.8% female; mean age, 57 y) the average duration of IBS symptoms was 17.7 years. Patients whose predominant symptom was severe diarrhea (diarrhea-predominant IBS) reported accepting a mean 10.2% ± 15.7% risk of sudden death for a 99% chance of cure. Pain catastrophizing scale scores were not associated with an increased likelihood of taking medication risks. Patients with IBS would be willing to pay an average amount of $73 per month (if annual income was <$75,000) and $197 per month (if annual income was >$75,000) for a medication that would resolve their pain.
In a survey of 215 patients with IBS, we found that patients with diarrhea-predominant IBS are willing to take extraordinary risks to improve their symptoms, whereas patients with IBS and pain catastrophization are not. Clinician understanding of patients' willingness to take medication risks might help them guide their patients through complex therapeutic options.
肠易激综合征（IBS）是一种常见的慢性功能性肠病，患者为改善症状会承担巨大风险。然而，目前尚无治愈 IBS 的方法。本研究评估了 IBS 患者对药物风险的承受意愿和改善症状所需支付的费用。
我们向符合罗马 IV 标准的 IBS 患者邮寄了一份关于药物风险的调查问卷。该调查收集了患者的人口统计学、症状、药物使用、既往药物回避事件和疼痛灾难化等数据。标准赌博评估了受访者对药物风险的承受意愿，而一系列支付意愿问题则量化了他们对治疗 IBS 的假设药物的最大支出。
在 215 名受访者（81.8%为女性；平均年龄为 57 岁）中，IBS 症状的平均持续时间为 17.7 年。以严重腹泻为主诉的患者（腹泻为主型 IBS）报告愿意接受 10.2%±15.7%的突发死亡风险，以换取 99%的治愈机会。疼痛灾难化量表评分与增加药物风险承受意愿无关。IBS 患者愿意每月支付 73 美元（如果年收入<75000 美元）和 197 美元（如果年收入>75000 美元）用于治疗疼痛的药物，如果该药物能够解决他们的疼痛问题。
在对 215 名 IBS 患者的调查中，我们发现腹泻为主型 IBS 患者愿意承担巨大风险来改善症状，而疼痛灾难化的 IBS 患者则不愿意。临床医生对患者药物风险承受意愿的理解可能有助于他们指导患者选择复杂的治疗方案。
