title: Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea.
abstract: BACKGROUND
  Irritable bowel syndrome (IBS) affects 10-15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population.
  
  
  METHODS
  Respondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics.
  
  
  RESULTS
  In total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p < 0.001; mean PCS: 47.29 vs. 50.67; p < 0.001; mean SF-6D: 0.677 vs. 0.741; p < 0.001) and greater absenteeism (5.1% vs. 2.9%; p = 0.004), presenteeism (17.9% vs. 11.3%; p < 0.001), overall work productivity loss (20.7% vs. 13.2%; p < 0.001), and activity impairment (29.6% vs. 18.9%; p < 0.001). Respondents with IBS-D also incurred an estimated $2486 more in indirect costs ($7008 vs. $4522; p < 0.001).
  
  
  CONCLUSIONS
  Compared with controls, IBS-D is associated with significantly lower HRQoL, greater impairments in work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.
authors.affiliation: Allergan plc, Jersey City, NJ, USA. Jessica.Abel@allergan.com.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Buono
authors.affiliation: Allergan plc, Jersey City, NJ, USA.
authors.forename: Robyn T
authors.initials: RT
authors.lastname: Carson
authors.affiliation: Kantar Health, Foster City, CA, USA.
authors.forename: Natalia M
authors.initials: NM
authors.lastname: Flores
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003967:Diarrhea / Q000150:complications / Q000191:economics* / Q000523:psychology*; D004651:Employment / Q000191:economics; D005260:Female; D006306:Health Surveys; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000191:economics* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Activity impairment; HRQoL; Health-related quality of life; IBS-D; Indirect costs; Irritable bowel syndrome with diarrhea; National Health and Wellness Survey; Work productivity impairment