Variation in Care for Patients with Irritable Bowel Syndrome in the United States

Brian E Lacy, Haridarshan Patel, Annie Guérin, Katherine Dea, Justin L Scopel, Reza Alaghband, Eric Qiong Wu, Reema Mody, Brian E Lacy, Haridarshan Patel, Annie Guérin, Katherine Dea, Justin L Scopel, Reza Alaghband, Eric Qiong Wu, Reema Mody

Abstract

Objectives: Irritable bowel syndrome (IBS) affects nearly one in seven Americans. Significant national variations in care may exist, due to a current lack of standardized diagnosis and treatment algorithms; this can translate into a substantial additional economic burden. The study examines healthcare resource utilization in patients with IBS and in the subset of IBS patients with constipation (IBS-C) and analyzes the variation of IBS care for these patients across the United States (US).

Methods: Healthcare resource use (HRU), including gastrointestinal (GI) procedures and tests, all-cause and intestinal-related medical visits, GI specialist visits, and constipation or diarrhea pharmacy prescriptions for IBS patients enrolled in a large US administrative claims database (2001-2012) were analyzed for the 24-month period surrounding first diagnosis. Multivariate regression models, adjusting for age, gender, year of first diagnosis, insurance type, and Charlson comorbidity index, compared HRU across states (each state vs. the average of all other states).

Results: Of 201,322 IBS patients included, 77.2% were female. Mean age was 49.4 years. One in three patients had ≥3 distinct GI medical procedures or diagnostic tests; 50.1% visited a GI specialist. Significant HRU differences were observed in individual states compared to the national average. IBS-C patients had more medical visits, procedures, and pharmacy prescriptions for constipation/diarrhea than IBS patients without constipation.

Conclusions: This study is the first to identify considerable regional variations in IBS healthcare across the US and to note a markedly higher HRU by IBS-C patients than by IBS patients without constipation. Identifying the reasons for these variations may improve quality of care and reduce the economic burden of IBS.

Conflict of interest statement

Competing Interests: This study was funded by Takeda Pharmaceuticals International. BEL has been a participant on the scientific advisory boards of Forest, Ironwood, Prometheus, Salix, and Takeda. RM and JLS are (or were) employees of Takeda at the time of project start and development. HP was a fellow working at Takeda at the time of the project start and development. HP is currently an employee of Immensity Consulting, Inc., which has received funding in the form of consulting fees from Takeda for other consulting projects. AG, KD, RA (former employee), and EQW are employees of Analysis Group, Inc., which has received consulting fees to conduct this analysis. Analysis Group, Inc. is an economic, financial, and strategy consulting firm that provides services to a variety of companies in the health care industry. The authors declare that they have no other financial competing interests. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1. Regional variation of medical procedures…
Fig 1. Regional variation of medical procedures and diagnostic tests.
Note: For IRR, incidence rate ratio, reference is the rest of US rate. Abbreviations: CT: computed tomography; US, United States. Map data reprinted from SAS software version 9.3 (Cary, NC) under a CC BY license, with permission from GfK GeoMarketing (Bruchsal, Baden-Württemberg, Germany), original copyright 2015.
Fig 2. Regional variation of GI medical…
Fig 2. Regional variation of GI medical procedures or diagnostic tests and pharmacy prescriptions for treating constipation or diarrhea.
Note: For OR, odds ratio, reference is the rest of US rate. Abbreviations: GI: gastrointestinal; US, United States. Map data reprinted from SAS software version 9.3 (Cary, NC) under a CC BY license, with permission from GfK GeoMarketing (Bruchsal, Baden-Württemberg, Germany), original copyright 2015.
Fig 3. Regional variation of the frequency…
Fig 3. Regional variation of the frequency of intestinal-related IP admissions, ER visits, and GI specialist visits.
Note: For IRR, incidence rate ratio, reference is the rest of US rate. Abbreviations: ER: emergency room; GI: gastrointestinal; IP: inpatient; US, United States. Map data reprinted from SAS software version 9.3 (Cary, NC) under a CC BY license, with permission from GfK GeoMarketing (Bruchsal, Baden-Württemberg, Germany), original copyright 2015.

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