title: Healthcare costs among patients with chronic constipation: a retrospective claims analysis in a commercially insured population.
abstract: OBJECTIVE
  To evaluate total annual all-cause, gastrointestinal-related, and symptom-related healthcare costs among chronic constipation (CC) patients and estimate incremental all-cause healthcare costs of CC patients relative to matched controls.
  
  
  METHODS
  Patients aged ≥18 years with continuous medical and pharmacy benefit eligibility in 2010 were identified from the HealthCore Integrated Research Database. CC patients had ≥2 medical claims for constipation (ICD-9-CM code 564.0x) ≥90 days apart or ≥1 medical claim for constipation plus ≥1 constipation-related pharmacy claim ≥90 days apart, and no medical claims for irritable bowel syndrome (IBS). Sub-groups with and without abdominal symptoms were classified according to the presence/absence of abdominal pain (ICD-9-CM code 789.0x) and bloating (ICD-9-CM code 787.3x). Controls without claims for constipation, abdominal pain, bloating, or IBS or constipation-related prescriptions were randomly selected and matched 1:1 with CC patients on age, gender, health plan region, and plan type. Generalized linear models with bootstrapping evaluated incremental all-cause costs attributable to CC, adjusting for demographics and comorbidities.
  
  
  RESULTS
  Overall, 14,854 patients (n = 7427 each in CC and control groups) were identified (mean age = 59 years; 75.4% female). Mean annual all-cause costs for CC patients were $11,991 (2010 USD), with nearly half (44.8%) attributable to outpatient services, including physician office visits and other outpatient services (10.0% and 34.8%, respectively). GI-related costs comprised 33.7% of total all-cause costs. Symptom-related costs accounted for 10.5%, primarily driven by costs of other outpatient services (50.6%). Adjusted incremental all-cause costs associated with CC were $3508 per patient per year ($4446 for CC with abdominal symptoms; $2783 for CC without abdominal symptoms), of which 81.0% were from medical services. Incremental cost estimates may be over- or under-estimated due to classification based on claims.
  
  
  CONCLUSIONS
  CC imposes a substantial burden in direct healthcare costs in a commercially insured population, mainly attributable to greater use of medical services.
authors.affiliation: HealthCore, Inc. , Wilmington, DE , USA.
authors.forename: Qian
authors.initials: Q
authors.lastname: Cai
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Buono
authors.forename: William M
authors.initials: WM
authors.lastname: Spalding
authors.forename: Phil
authors.initials: P
authors.lastname: Sarocco
authors.forename: Hiangkiat
authors.initials: H
authors.lastname: Tan
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.forename: Robyn T
authors.initials: RT
authors.lastname: Carson
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003248:Constipation / Q000191:economics*; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors