Abstract
BackgroundNearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation.MethodsLiterature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose–response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter.ResultsThe base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion.ConclusionsIncreasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes.
Highlights
Five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption
The decision-analytic model was developed using and estimates the direct medical cost savings associated with constipation among adults based on the following factors: (1) baseline dietary fiber consumption; (2) prevalence of constipation among those not meeting dietary fiber intake recommendations; (3) proportion of those likely to respond, in terms of alleviation of constipationassociated symptoms, to increased dietary fiber intakes; (4) estimated decrease in constipation prevalence associated with each 1 g/day increase of dietary fiber intake; and (5) expected change in dietary fiber intake
The base case assumes that 3% of the adult male population and 6% of the adult female population meet dietary fiber recommendations [2] and that 4.6% of adults have functional constipation [22]
Summary
Five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. Current dietary fiber intakes in the United States are far below recommended levels [1], with recent estimates indicating that less than three percent of men and only six percent of women meet recommendations [2]. Reports of the prevalence of functional constipation, referred to as chronic idiopathic constipation, vary widely, ranging from 1.9 to 27.1% in the general U.S population [21,22] These variations result from differences in important factors such as how constipation is defined and how cases are ascertained (e.g., self-report vs clinical evaluation). The frequency of medical visits for constipation-related care has increased considerably in the last 20 years, representing a growing economic burden for both the patient and medical provider, with the number of physician visits totaling 4 million from 1993 through 1996 and 7.95 million from 2001 through 2004 [27]
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