title: Constipation-related direct medical costs in 16 887 patients newly diagnosed with chronic constipation.
abstract: BACKGROUND
  Chronic constipation is a common condition, but the exact impact on healthcare budgets in Western Europe is poorly documented.
  
  
  OBJECTIVE
  The aim of this study was to (a) investigate chronic constipation-related direct medical costs in patients with newly diagnosed chronic constipation and (b) study differences in costs according to natural history.
  
  
  METHODS
  We identified 16 887 patients newly diagnosed with chronic constipation in a Dutch health insurance database (∼1.3 million patients) in 2006-2009. Individuals with chronic constipation were selected on the basis of chronic laxative use (≥90 days/year) and diagnostic related groups for chronic constipation. On the basis of the episodes of laxative use and diagnostic related groups, individuals were categorized as having persistent, episodic, and nonrecurrent disease. Unadjusted costs for laxatives and hospital care for chronic constipation and constipation-related comorbidities were assessed and compared between patients with nonrecurrent, episodic, and persistent disease. Factors associated with costs were identified using Cox regression analyses.
  
  
  RESULTS
  The mean total chronic constipation-related direct medical costs in the first year after diagnosis were &OV0556;310±845 and consisted of laxatives (45%) and hospital care for chronic constipation (26%) as well as constipation-related comorbidities (29%). Costs were highest in patients with persistent disease (&OV0556;367±882) compared with patients with episodic (&OV0556;292±808) and nonrecurrent (&OV0556;263±613) disease (P<0.01). Male sex was associated with higher costs, whereas increasing age, diabetes, and use of opioids were associated with lower costs.
  
  
  CONCLUSIONS
  Pharmacy costs and hospital care costs for chronic constipation-related comorbidities were the largest cost drivers for total constipation-related direct medical costs in patients with newly diagnosed chronic constipation. Direct medical costs differed according to patient characteristics.
authors.affiliation: aDepartment of Gastroenterology and Hepatology bJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht cAchmea Health Insurance, Amersfoort, The Netherlands dShire, Eysins, Switzerland eGlobal Development & Medical Affairs, Shire Development LLC, Wayne, Pennsylvania fDivision of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Vincent K
authors.initials: VK
authors.lastname: Dik
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Alain
authors.initials: A
authors.lastname: Joseph
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
authors.forename: Hugo M
authors.initials: HM
authors.lastname: Smeets
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D054368:Laxatives