Economic burden of inadequate symptom control among US commercially insured patients with irritable bowel syndrome with diarrhea

Abstract

Aims: To assess healthcare resource use and costs among irritable bowel syndrome (IBS) with diarrhea (IBS-D) patients with and without evidence of inadequate symptom control on current prescription therapies and estimate incremental all-cause costs associated with inadequate symptom control.

Methods: IBS-D patients aged ≥18 years with ≥1 medical claim for IBS (ICD-9-CM 564.1x) and either ≥2 claims for diarrhea (ICD-9-CM 787.91, 564.5x), ≥1 claim for diarrhea plus ≥1 claim for abdominal pain (ICD-9-CM 789.0x), or ≥1 claim for diarrhea plus ≥1 pharmacy claim for a symptom-related prescription within 1 year of an IBS diagnosis were identified from the Truven Health MarketScan database. Inadequate symptom control, resource use, and costs were assessed up to 1 year following the index date. Inadequate symptom control included any of the following: (1) switch or (2) addition of new symptom-related therapy; (3) IBS-D-related inpatient or emergency room (ER) admission; (4) IBS-D-related medical procedure; (5) diagnosis of condition indicating treatment failure; or (6) use of a more aggressive prescription. Generalized linear models assessed incremental costs of inadequate symptom control.

Results: Of 20,624 IBS-D patients (mean age = 48.5 years; 77.8% female), 66.4% had evidence of inadequate symptom control. Compared to those without inadequate symptom control, patients with evidence of inadequate symptom control had significantly more hospitalizations (12.0% vs 6.0%), ER visits (37.1% vs 22.6%), use of outpatient services (73.0% vs 60.7%), physician office visits (mean 11.0 vs 8.1), and prescription fills (mean 40.0 vs 26.7) annually (all p < .01). Incremental costs associated with inadequate symptom control were $3,065 (2013 US dollars), and were driven by medical service costs ($2,391; 78%).

Limitations: Study included US commercially insured patients only and inferred IBS-D status and inadequate symptom control from claims.

Conclusions: Inadequate symptom control associated with available IBS-D therapies represents a significant economic burden for both payers and IBS-D patients.

Keywords:

• Irritable bowel syndrome with diarrhea
• treatment
• symptom control
• economic burden
• healthcare resource use

Transparency

Declaration of funding

Funding for this manuscript was provided by Allergan plc. The authors received no compensation related to the development of the manuscript.

Declaration of financial/other relationships

JLB and DAA are employees of Allergan plc and own stock/stock options. KM is an employee of Axtria Inc. AJA was an employee of Axtria Inc. at the time this study was conducted. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

Data included in this manuscript were presented in poster form at the Academy of Managed Care Pharmacy Nexus Meeting, Orlando, FL, October 26–29, 2015.

Acknowledgments

The authors would like to thank Steven J. Shiff, MD, for providing clinical consultation on patient identification criteria and disease comorbidities. They would also like to thank Karen B. Chien, PhD, of Complete HealthVizion, Inc., Chicago, IL, for editorial assistance in the writing and revision of the draft manuscript on the basis of detailed discussion and feedback from all the authors, funded by Allergan plc.