title: Use of health care resources and cost of care for adults with constipation.
abstract: OBJECTIVE
  Constipation is a multisymptom disorder that frequently compromises quality of life and leads patients to seek medical advice. To evaluate the clinical and fiscal effects of constipation, we assessed health care resource use by patients with constipation enrolled in a large state Medicaid program.
  
  
  METHODS
  We identified 105,130 patients older than age 18 who saw a physician at least once for constipation and were enrolled in the California Medicaid program (Medi-Cal). We then studied health care resource use and costs (reimbursed by Medi-Cal) in 76,854 patients without supplementary insurance. The 15-month analysis period encompassed 3 months before and 12 months after the first visit. The prevalence of comorbid conditions was assessed in the sample of 105,130 patients.
  
  
  RESULTS
  During the study period, 106,555 physician visits were for constipation; the total associated cost was $3,016,017 ($39/patient). The total cost for gastrointestinal procedures and laboratory testing was $14,052,503 ($183/patient). There were 41,723 over-the-counter and 1665 prescription drug purchases; the total cost was $388,780 ($5/patient). Approximately 0.6% of patients (n = 479) were admitted to the hospital for constipation; the total cost was $1,433,708 ($2993/admission). The total direct health care costs for patients with constipation in the Medi-Cal system for the 15-month period was $18,891,008 ($246/patient). Within 12 months of the first physician visit for constipation, 5657 of 105,130 patients had hemorrhoids and 2288 had intestinal impaction or obstruction.
  
  
  CONCLUSIONS
  Adults seeking treatment for constipation account for significant health care resource use and often have comorbid conditions. The clinical and fiscal burden of constipation in US adults cannot be disregarded or trivialized.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Gurkirpal
authors.initials: G
authors.lastname: Singh
authors.forename: Vijayabharathi
authors.initials: V
authors.lastname: Lingala
authors.forename: Huijian
authors.initials: H
authors.lastname: Wang
authors.forename: Shweta
authors.initials: S
authors.lastname: Vadhavkar
authors.forename: Kristijan H
authors.initials: KH
authors.lastname: Kahler
authors.forename: Alka
authors.initials: A
authors.lastname: Mithal
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D003248:Constipation / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence