Healthcare Cost Comparisons by Point of Service for Persons with or without Constipation

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Purpose: To compare the costs of healthcare by point of service (POS) for persons with or without constipation. Methods: A retrospective analysis of an employer database containing medical claims, payroll, and demographic data over the years 2001–2005 was accessed. Annual healthcare costs for employees with or without constipation were compared for care received in: doctor's office, inpatient hospital, outpatient hospital or clinic, emergency department (ED), laboratory, and other. ICD-9 Codes 564.0 (Constipation), 564.00 (Unspecified), 564.01 (Slow Transit), and 564.09 (Other) were used to distinguish employees with constipation (C) from the nonconstipation (NC) cohort (employees with no claims for these ICD-9 codes). The index date in the C cohort was defined as 3 months prior to the date of first diagnosis during 2001 or later; the average C index date was used in the NC cohort. Two-part regression models were used to compare each category of costs between cohorts. Age, gender, marital status, race, salary and other job-related variables, region of the US, and Charlson Comorbidity Index score were included in the models as independent variables to control for possible confounding factors. Results: Data were available for 1138 persons with C and 113701 NC controls. Overall, the constipation cohort was 1.86 years younger, 12.7% more likely to be female, 6.6% less likely to be white, 3.3% more likely to be black, 1.5% more likely to work full-time, and compensated $4966 less in annual salary per person (all P≤ 0.001). The C cohort incurred $3105 per person additional annual costs for all services. Costs by category for the C cohort versus NC cohort were: outpatient hospital or clinic ($2135 vs. $733), inpatient hospital ($1645 vs. $581), doctor's office ($1064 vs. $561), ED ($141 vs. $45), laboratory ($27 vs. $9), and other locations ($51 vs. $29). The incremental increase in cost (%) for C (vs. the NC cohort) by POS category were: outpatient hospital or clinic (45.2%), inpatient hospital (34.3%), doctor's office (16.2%), ED (3.1%), laboratory (0.6%), and other locations (0.7%). All POS category comparisons were significant (P≤ 0.0002). Conclusions: Patients with constipation have significantly higher costs of care throughout the healthcare system and at all POS locations.