title: Economic burden of inadequate symptom control among US commercially insured patients with irritable bowel syndrome with diarrhea.
abstract: OBJECTIVE
  To assess healthcare resource use and costs among irritable bowel syndrome (IBS) with diarrhea (IBS-D) patients with and without evidence of inadequate symptom control on current prescription therapies and estimate incremental all-cause costs associated with inadequate symptom control.
  
  
  METHODS
  IBS-D patients aged ≥18 years with ≥1 medical claim for IBS (ICD-9-CM 564.1x) and either ≥2 claims for diarrhea (ICD-9-CM 787.91, 564.5x), ≥1 claim for diarrhea plus ≥1 claim for abdominal pain (ICD-9-CM 789.0x), or ≥1 claim for diarrhea plus ≥1 pharmacy claim for a symptom-related prescription within 1 year of an IBS diagnosis were identified from the Truven Health MarketScan database. Inadequate symptom control, resource use, and costs were assessed up to 1 year following the index date. Inadequate symptom control included any of the following: (1) switch or (2) addition of new symptom-related therapy; (3) IBS-D-related inpatient or emergency room (ER) admission; (4) IBS-D-related medical procedure; (5) diagnosis of condition indicating treatment failure; or (6) use of a more aggressive prescription. Generalized linear models assessed incremental costs of inadequate symptom control.
  
  
  RESULTS
  Of 20,624 IBS-D patients (mean age = 48.5 years; 77.8% female), 66.4% had evidence of inadequate symptom control. Compared to those without inadequate symptom control, patients with evidence of inadequate symptom control had significantly more hospitalizations (12.0% vs 6.0%), ER visits (37.1% vs 22.6%), use of outpatient services (73.0% vs 60.7%), physician office visits (mean 11.0 vs 8.1), and prescription fills (mean 40.0 vs 26.7) annually (all p < .01). Incremental costs associated with inadequate symptom control were $3,065 (2013 US dollars), and were driven by medical service costs ($2,391; 78%).
  
  
  CONCLUSIONS
  Study included US commercially insured patients only and inferred IBS-D status and inadequate symptom control from claims.
  
  
  CONCLUSIONS
  Inadequate symptom control associated with available IBS-D therapies represents a significant economic burden for both payers and IBS-D patients.
authors.affiliation: a Allergan plc , Jersey City , NJ , USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Buono
authors.affiliation: b Axtria Inc. , Berkeley Heights , NJ , USA.
authors.forename: Kush
authors.initials: K
authors.lastname: Mathur
authors.affiliation: b Axtria Inc. , Berkeley Heights , NJ , USA.
authors.forename: Amelia J
authors.initials: AJ
authors.lastname: Averitt
authors.affiliation: a Allergan plc , Jersey City , NJ , USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Andrae
mesh_terms: D000328:Adult; D000368:Aged; D000930:Antidiarrheals / Q000191:economics / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D003967:Diarrhea / Q000191:economics* / Q000209:etiology* / Q000628:therapy; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D043183:Irritable Bowel Syndrome / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009819:Office Visits / Q000191:economics; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use
chemical_list: D000930:Antidiarrheals; D018680:Cholinergic Antagonists; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Irritable bowel syndrome with diarrhea; economic burden; healthcare resource use; symptom control; treatment