Pharmacologic Dietary and Psychological Treatments for IrritableBowel Syndrome With Constipation: Cost Utility Analysis

摘要

Introduction. Irritable bowel syndrome (IBS) is the most commongastroenterology referral and one of the most common gastrointestinal complaintsin primary care. We performed a cost-utility analysis of the most commontreatments available in general practice for IBS with constipation (IBS-C), themost expensive IBS subtype. Methods. We developed a decisionanalytic model evaluating guideline-recommended and Food and DrugAdministration–approved drugs, supplements, and dietary/psychologicalinterventions. Model inputs were derived from “global symptom improvement”outcomes in systematic reviews of clinical trials. Costs were derived fromnational datasets. Analysis was performed with a 1-year time horizon frompatient and payer perspectives. We analyzed a prototypical managed-care healthplan with no cost-sharing to the patient. Results. From a payerperspective, global IBS treatments (including low FODMAP, cognitive behavioraltherapy [CBT], neuromodulators), which are not specific to the IBS-C bowelsubtype were less expensive than on-label prescription drug treatments. From apatient perspective, on-label prescription drug treatment with linaclotide wasthe least expensive treatment strategy. Drug prices and costs to manageuntreated IBS-C were most important determinants of payer treatment preferences.Effects of treatment on missed work-days and need for repeated appointments tocomplete treatment were the most important determinants of treatment preferenceto patients. Discussion. Due mostly to prescription drug prices,neuromodulators, low FODMAP, and CBT appear cost-effective compared to on-labeldrug treatments from a payer perspective in cost-utility analysis. Thesefindings may explain common treatment barriers in clinical practice.