Variation in Care for Patients with Irritable Bowel Syndrome in the United States

PLoS One. 2016 Apr 26;11(4):e0154258. doi: 10.1371/journal.pone.0154258. eCollection 2016.

Abstract

Objectives: Irritable bowel syndrome (IBS) affects nearly one in seven Americans. Significant national variations in care may exist, due to a current lack of standardized diagnosis and treatment algorithms; this can translate into a substantial additional economic burden. The study examines healthcare resource utilization in patients with IBS and in the subset of IBS patients with constipation (IBS-C) and analyzes the variation of IBS care for these patients across the United States (US).

Methods: Healthcare resource use (HRU), including gastrointestinal (GI) procedures and tests, all-cause and intestinal-related medical visits, GI specialist visits, and constipation or diarrhea pharmacy prescriptions for IBS patients enrolled in a large US administrative claims database (2001-2012) were analyzed for the 24-month period surrounding first diagnosis. Multivariate regression models, adjusting for age, gender, year of first diagnosis, insurance type, and Charlson comorbidity index, compared HRU across states (each state vs. the average of all other states).

Results: Of 201,322 IBS patients included, 77.2% were female. Mean age was 49.4 years. One in three patients had ≥3 distinct GI medical procedures or diagnostic tests; 50.1% visited a GI specialist. Significant HRU differences were observed in individual states compared to the national average. IBS-C patients had more medical visits, procedures, and pharmacy prescriptions for constipation/diarrhea than IBS patients without constipation.

Conclusions: This study is the first to identify considerable regional variations in IBS healthcare across the US and to note a markedly higher HRU by IBS-C patients than by IBS patients without constipation. Identifying the reasons for these variations may improve quality of care and reduce the economic burden of IBS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Constipation / economics*
  • Constipation / epidemiology
  • Cost of Illness
  • Female
  • Humans
  • Irritable Bowel Syndrome / economics*
  • Irritable Bowel Syndrome / epidemiology
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care* / statistics & numerical data
  • United States / epidemiology

Grants and funding

Research for this article was funded by the sponsor, Takeda Pharmaceuticals International. The study was designed by the senior authors (BEL, AG, EQW) and the sponsor employees HP, RM, and JLS. Data were collected by Analysis Group authors KD and RA and analyzed and interpreted in collaboration with all authors. All authors participated in the design of the study and contributed to the manuscript development. Although sponsor employees HP, RM, and JLS were involved in the design, collection, analysis, and interpretation of information, the content of this manuscript, the ultimate interpretation, and the decision to submit it for publication were made by each of the authors independently. All the authors vouch for the accuracy and completeness of the data reported and for the adherence of the study to the protocol. Takeda Pharmaceuticals International, Inc., Immensity Consulting, Inc., and Analysis Group, Inc. provided support in the form of salaries for the authors employed as listed in the ‘competing interests’ section, but these companies did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section.