Comprehensive study on the administrative, economic, regional, and regulatory prospects of complementary and alternative medicine (CAM) in inflammatory bowel disease (IBD)

ABSTRACT

Introduction: Due to the high cost, low effectiveness, and adverse effects plus the life-long nature of inflammatory bowel disease (IBD), and misconception on safety, efficacy, and cost-effectiveness of complementary and alternative medicine (CAM), the market demand for CAM has risen over the past decades. A critical review of patients’ and physicians’ attitudes, market drivers, economic aspects, regulatory roles, and regional distribution is lacking.

Areas covered: Through relevant databases, the existing English language literature concerning the association of CAM use with IBD was collected over the past two decades. Data was then analyzed, comprehensively summarized in tables/figures, and justified concerning administrative, organizational, regional, economic, and regulatory perspectives.

Expert opinion: Although CAM utilization is more prevalent among younger, female, and high-educated IBD patients, issues concerning weak study designs, limited-time period/regional distribution of recent surveys, and lack of economic evaluations on CAM make it entirely unfeasible to draw a firm conclusion. Regulators are lagging in meeting the dire need of IBD patients, especially the elderly. Lack of legislation regarding registration, sales monitoring, licensing, insurance coverage, efficacy/safety assessments, post-marketing surveillance, quality assurance, and reference pricing alongside the limited support for CAM research are the main matters that should be urgently addressed.

KEYWORDS:

• Complementary and alternative medicine (CAM)
• Inflammatory bowel disease (IBD)
• Prevalence
• Regulation
• Economic
• Crohn’s Disease (CD)
• Ulcerative Colitis (UC)
• Epidemiology
• Cost-effectiveness analysis
• Safety

Article highlights

• Among chronic gastrointestinal disorders, IBD with globally affecting 6.8 million in 2017, and imposing high direct and indirect annual costs has been considered as one of the considerable threats to patients, health care systems and governments.

• Due to the high cost, poor effectiveness and adverse effects of medications along with life-long nature of the disease, patients have been pushed toward using CAM; however, there is no accurate data supporting its efficacy, safety, and cost-effectiveness in IBD.

• Issues regarding poor design, limited duration and regional distribution of former surveys, and lack of recent economic evaluations, make it difficult to reach a firm conclusion on administrative, economical, regulatory and distribution of CAM use among IBD patients.

• What is clear is that younger, female, and high-educated IBD patients more tend towards using CAM; all of which were justified within the article.

• Improving population knowledge, providing financial funding, establishing research and development institutes and expert committees, applying homogenous research methodologies and standardizing questionnaires should be implemented in following years.

• Furthermore, there is an urgent need for networking HCPs and CAM practitioners, imposing strict legislations, unifying the explanation on CAM products/services worldwide, providing partial/full insurance for CAM practices, compiling internal/external reference pricing, and in short, incorporating CAM services into global health care systems.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The paper was not funded.