Assessment of Practice Patterns and Treatment-Failure Costs among Patients with Irritable Bowel Syndrome with Constipation or Chronic Constipation: Findings from a Physician Survey Study

Abstract

Purpose: To understand resource utilization and associated costs for patients with irritable bowel syndrome with constipation (IBS-C) or chronic constipation (CC) based on treatment response. Methods: A web-based survey was conducted with a sample of primary care physicians (PCPs) and gastroenterologists (GEs) across different US regions. The survey captured data on referral patterns (to/from gastroenterologists), test/procedure ordering, and follow-up physician visits for typical patients who did and did not achieve satisfactory relief of symptoms to a recent treatment for IBS-C or CC (“response”). Survey items included questions regarding the proportion of patients who would receive tests/procedures and follow-up physician visits. Healthcare costs were estimated by applying associated unit costs (derived from the 2012 Medicare physician payment schedule) to the corresponding utilization. All patients were assumed to begin treatment with PCPs. The median and mean costs of treatment failure were calculated as the corresponding cost differences between physician-deemed non-responders and responders, incorporating both PCP work-up costs and the costs of referrals to GEs. Results: 20 PCPs and 21 GEs completed the survey. Mean monthly number of adults treated by these physicians was 61 for IBS-C and 58 for CC. Most non-responders would be referred to a GE by PCPs for both IBS-C (median: 80%; mean: 72%) and CC (median: 78%; mean: 68%). Non-responders would be more likely to receive a test/procedure compared to responders, for both IBS-C (median: 75 vs. 0% for PCPs; 50 vs. 0% for GEs; mean: 65 vs. 10% for PCPs; 56 vs. 33% for GEs) and CC (median: 90 vs. 0% for both PCPs and GEs; mean: 72 vs. 5% for PCPs; 72 vs. 24% for GEs). Thyroid function tests and colonoscopy were the most common tests/procedures that would be ordered for both conditions. The median (mean) expected cost of treatment failure was estimated to be $825 ($613) for IBS-C and $1,132 ($865) for CC. Conclusion: Patients with IBS-C or CC who experience a lack of response to treatment may have higher healthcare resource use and costs, a finding of potential interest to payers. Disclosure: Huan Huang and Joseph Menzin: employees of Boston Health Economics, a consultancy whose activities related to this project are funded by Forest Laboratories, Inc. and Ironwood Pharmaceuticals, Inc.; Robyn Carson and Steven Blum: employees of Forest Laboratories, Inc. and owns stock and/or stock options in Forest Laboratories; Phil Sarocco and Doug Taylor: employees of Ironwood Pharmaceuticals, Inc. and own stock and/or stock options in Ironwood Pharmaceuticals. This research was supported by an industry grant from Forest Laboratories, Inc., and Ironwood Pharmaceuticals, Inc., were involved in the study design; collection, analysis and data interpretation; and decision to submit these data for presentation. Study was sponsored by Forest Laboratories, Inc., and Ironwood Pharmaceuticals, Inc.