Evaluating Diagnostic and Pharmacologic Management Cost of Chronic Abdominal Pain and Chronic Constipation in Iranian Children

Abstract

Background: Abdominal pain and constipation are the most common symptoms in children and because of lacking a well-defined diagnostic criteria for these symptoms various aspect of medical care in these patients are increased. Objectives: The current study aimed to evaluate the number and the cost of diagnostic and pharmacologic management of chronic abdominal pain and chronic constipation in children aged less than 18 years managed by general physicians or pediatricians before the patient is examined by pediatric gastroenterologist. Patients and Methods: In a cross-sectional study a sample of 91 consecutive patients with chronic abdominal pain and chronic constipation aged less than 18 years managed by pediatricians and general physicians were interviewed, examined and a questionnaires (based on the Rome III criteria) were filled, before they visited a pediatric gastroenterologist in an outpatient gastroenterology clinic. Cost and number of pharmacologic management and paraclinical workups done were calculated in total for the two symptoms separately. Results: There were 91 patients, among which 55 (60.4%) had come with chronic abdominal pain and 36 (39.6%) had come with chronic constipation. The calculated cost per case for general physician and pediatrician visits and paraclinical and pharmacological management for patients with chronic abdominal pain was $ 65.1 and for chronic constipation was $ 53.2. For chronic abdominal pain cost per case for general physician visit was $ 8.6, for pediatricians was $ 26.9, for paraclinical management was $ 27.7 and for pharmacological management was $ 1.9. Similarly for the patients with chronic constipation cost per case for general physician visit was $ 14.8, for pediatricians was $ 28.1, for paraclinical management was $ 7.7, and for pharmacological management was $ 2.6. Conclusions: This study suggests that symptoms like chronic abdominal pain, and chronic constipation seem to put a heavy burden on the economy of the country, so training programs for pediatricians and general physicians that can well train them to handle such symptoms may decrease the number of clinical visits, repetitive investigation procedures, and utilizing multiple prescription drugs. Also media, magazines, booklets in hospitals, clinics and drug stores can help to educate parents and they in turn can cooperate better with the physician and will cope with long term symptoms of such problems in their children better.