title: Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model.
abstract: BACKGROUND
  Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation.
  
  
  METHODS
  Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose-response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter.
  
  
  RESULTS
  The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion.
  
  
  CONCLUSIONS
  Increasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes.
authors.forename: Jordana K
authors.initials: JK
authors.lastname: Schmier
authors.forename: Paige E
authors.initials: PE
authors.lastname: Miller
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Levine
authors.affiliation: Exponent Inc,, 525 W, Monroe Street Suite 1050, Chicago, IL 60661, USA. vperez@exponent.com.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Perez
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Maki
authors.forename: Tia M
authors.initials: TM
authors.lastname: Rains
authors.forename: Latha
authors.initials: L
authors.lastname: Devareddy
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sanders
authors.forename: Dominik D
authors.initials: DD
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000191:economics* / Q000517:prevention & control; D017046:Cost Savings; D004043:Dietary Fiber / Q000008:administration & dosage* / Q000627:therapeutic use; D005247:Feeding Behavior; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D014481:United States
references.citation: Am J Gastroenterol. 2003 Aug;98(8):1790-6
references.pmid: 12907334
references.citation: Dig Dis Sci. 1989 Apr;34(4):606-11
references.pmid: 2784759
references.citation: J Am Diet Assoc. 2008 Oct;108(10):1716-31
references.pmid: 18953766
references.citation: Am J Clin Nutr. 2007 Dec;86(6):1730-7
references.pmid: 18065593
references.citation: Arch Intern Med. 2004 Feb 23;164(4):370-6
references.pmid: 14980987
references.citation: J Paediatr Child Health. 2008 Apr;44(4):170-5
references.pmid: 17854410
references.citation: J Am Diet Assoc. 2002 Nov;102(11):1621-30
references.pmid: 12449285
references.citation: J Am Med Dir Assoc. 2002 Jul-Aug;3(4):215-23
references.pmid: 12807641
references.citation: Am J Gastroenterol. 2004 Apr;99(4):750-9
references.pmid: 15089911
references.citation: Am J Gastroenterol. 1999 Dec;94(12):3530-40
references.pmid: 10606315
references.citation: Aliment Pharmacol Ther. 2007 Jul 15;26(2):237-48
references.pmid: 17593069
references.citation: BMJ. 2011 Nov 10;343:d6617
references.pmid: 22074852
references.citation: Am J Gastroenterol. 2008 Jul;103(7):1746-53
references.pmid: 18557708
references.citation: Am J Clin Nutr. 2003 Nov;78(5):920-7
references.pmid: 14594777
references.citation: Aliment Pharmacol Ther. 2007 Mar 1;25(5):599-608
references.pmid: 17305761
references.citation: Clin Gastroenterol Hepatol. 2007 Sep;5(9):1053-8
references.pmid: 17625982
references.citation: Proc Nutr Soc. 2003 Feb;62(1):151-60
references.pmid: 12749340
references.citation: Ann Oncol. 2012 Jun;23(6):1394-402
references.pmid: 22234738
references.citation: J Nutr. 2009 Mar;139(3):576-81
references.pmid: 19158230
references.citation: Am J Gastroenterol. 1997 Jan;92(1):95-8
references.pmid: 8995945
references.citation: J Pediatr Gastroenterol Nutr. 1999 Feb;28(2):169-74
references.pmid: 9932850
references.citation: Postgrad Med. 2011 May;123(3):122-32
references.pmid: 21566422
references.citation: Am J Gastroenterol. 2011 Sep;106(9):1582-91; quiz 1581, 1592
references.pmid: 21606976
references.citation: J Nutr. 1998 Apr;128(4):714-9
references.pmid: 9521633
references.citation: Eur J Clin Nutr. 2013 Jan;67(1):96-100
references.pmid: 23073261
references.citation: BMJ. 2011 Jul 19;343:d4131
references.pmid: 21771850
references.citation: J Fam Health Care. 2002;12(5):127-32
references.pmid: 12449063
references.citation: J Nutr. 2012 Jul;142(7):1304-13
references.pmid: 22649266
references.citation: Int J Food Sci Nutr. 2012 Dec;63(8):1001-13
references.pmid: 22716911
references.citation: J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):e1-13
references.pmid: 16954945
references.citation: Braz J Med Biol Res. 2003 Jun;36(6):753-9
references.pmid: 12792705
references.citation: J Child Health Care. 2009 Jun;13(2):116-27
references.pmid: 19458167
references.citation: J Pediatr Gastroenterol Nutr. 2006 Mar;42(3):270-4
references.pmid: 16540795
references.citation: Adv Nutr. 2011 May;2(3):293-4
references.pmid: 22332062
references.citation: J Pediatr. 2005 Mar;146(3):359-63
references.pmid: 15756220
references.citation: Pediatrics. 1995 Nov;96(5 Pt 2):999-1000
references.pmid: 7494681
references.citation: Pharmacoeconomics. 2005;23(5):461-76
references.pmid: 15896098
references.citation: J Pediatr Gastroenterol Nutr. 2006 Oct;43(4):477-82
references.pmid: 17033522
references.citation: Arch Intern Med. 2007 May 14;167(9):956-65
references.pmid: 17502538
references.citation: J Pediatr Gastroenterol Nutr. 1999 Aug;29(2):132-5
references.pmid: 10435648
references.citation: Gastroenterology. 2006 Apr;130(5):1377-90
references.pmid: 16678553
references.citation: Am J Gastroenterol. 2013 May;108(5):796-803
references.pmid: 23567352
references.citation: Aliment Pharmacol Ther. 2011 Jan;33(2):251-60
references.pmid: 21091523
references.citation: J Pediatr. 2009 Feb;154(2):258-62
references.pmid: 18822430