PGI13 Evaluation of the Clinical and Economic Burden of Chronic Constipation in Belgium

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Constipation is considered an inconvenient problem, however data on the real burden is lacking. The objective of the current analysis was to assess the clinical and economic burden of chronic constipation in Belgium. From the IMS Hospital Disease Database (year 2007), which includes data on full hospitalizations and day clinic for 34.3% of Belgian hospital beds, stays of patients with constipation were selected based on the ICD-9-CM code (564.0) with constipation as a primary diagnosis. The database allows to estimate length of stay (LOS), in-hospital mortality, performed interventions, ATC classified medication usage, and cost of hospitalisation. Using the 34% coverage, a national projection was made for the number of hospital stays and burden of disease. 2007 costs were extrapolated to 2010 using progression in costs from 2001 to 2007. ATC codes for osmotic/contact laxatives, softeners, bulking agents, enemas and peripheral opioid receptor antagonists were used. Occurrence of relevant co-morbidities was analyzed using applicable ICD-9-CM codes. There were 6338 hospital day clinic stays and full hospitalizations (LOS 5.44 days). About 42% of the patients were admitted via the ER. Most occurring co-morbidities were hemorrhoids (174), fecal impaction (74) and intestinal obstruction (53). Mortality rate was 0.46% meaning 29 deaths in hospitalizations for constipation. Especially in hospitalized patients, usage of enemas was pronounced (34.17%). Osmotically acting laxatives are the most used agents (39.58%). The average costs per patient was €1883, consisting of medication costs, procedural costs and stay costs of €112, €675 and €1097, respectively. Extrapolated to Belgium the total hospitalization cost for constipation was approximately €11.9 million. Hospital stay is more frequent in the elderly particularly in elderly females. Constipation is an underestimated disease condition reflected by hospital related costs of about €11.9 million and approximately 29 death cases in Belgium in 2007.