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



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).



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.



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.
Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States of America.
Brian E
BE
Lacy
Immensity Consulting, Inc., Chicago, Illinois, United States of America.
Haridarshan
H
Patel
Analysis Group, Inc., Montreal, QC, Canada.
Annie
A
Guérin
Analysis Group, Inc., Montreal, QC, Canada.
Katherine
K
Dea
US Medical Affairs, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois, United States of America.
Justin L
JL
Scopel
Analysis Group, Inc., Montreal, QC, Canada.
Reza
R
Alaghband
Analysis Group, Inc., Boston, Massachusetts, United States of America.
Eric Qiong
EQ
Wu
Global Outcomes and Epidemiology Research, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois, United States of America.
Reema
R
Mody
D000328:Adult; D003248:Constipation / Q000191:economics* / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology