Medical, Pharmacy, and Sick Leave Costs for Constipation and for Irritable Bowel Syndrome with Constipation in the 6 Months before and after Diagnosis: An Employer Perspective

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Purpose: Both constipation (C) and irritable bowel syndrome with C (IBS+C) are known to be very costly. However, whether the costs of C are driven by the same factors that drive IBS+C costs is unknown. We aimed to assess the cost of illness (COI) for C without and with IBS (IBS+C) among US-based employees. Methods: A retrospective analysis was conducted using the Human Capital Management Services Research database, which represents multiple US-based employers and contains employee health claims data from 2001–2005. Data included medical, pharmacy, payroll, work absence, and demographics. ICD9 Codes were used to include employees in the C cohort: 564.0 (Constipation), 564.00 (Unspecified), 564.01 (Slow Transit), and 564.09 (Other). Employees with C and an ICD9 for IBS (564.1×) at any time were included in the IBS+C cohort. Propensity scores based on demographics, job-related variables, region, existence of medical claims, and Charlson Comorbidity Index Score were used to match 5 C employees to each IBS+C cohort employee. For the C cohort the index date was the date of the first C claim. For the IBS+C cohort the index date was the date of the first IBS claim. Mean costs for each cohort were adjusted to 2006$ and compared by category for medical, prescription drug (Rx), and sick leave costs in the 6-months before and after index diagnosis (dx). Results: Data were available for 1854 employees. Demographics for both cohorts were similar (P > .05). All between cohort COI comparisons (Figure) were similar (P > .05), except for Rx costs after dx ($26 higher for IBS+C, P= .036). Within cohort comparisons (6-months before vs. after dx) identified significant increases in medical and Rx costs for both cohorts (P≤ .05). Sick leave costs and days increased after dx in both C and IBS+C cohorts (P > .05). Persons with IBS+C averaged an additional 1.3 sick leave days during the 6-month period after dx when compared with the C cohort (P < .03). Conclusion: Costs of illness for IBS+C and C are very similar. Total costs and sick leave days for both cohorts increased after dx.[figure1]Figure