The Humanistic and Economic Burden of Chronic Idiopathic Constipation in the USA: A Systematic Literature Review

Arpita Nag, Susan A Martin, Deirdre Mladsi, Oyebimpe Olayinka-Amao, Molly Purser, Renu M Vekaria, Arpita Nag, Susan A Martin, Deirdre Mladsi, Oyebimpe Olayinka-Amao, Molly Purser, Renu M Vekaria

Abstract

Background: Chronic idiopathic constipation (CIC) is a functional gastrointestinal disorder with an estimated prevalence of 16% in the USA; however, the humanistic and economic burden of CIC is poorly characterized.

Aim: This systematic literature review aimed to assess the humanistic and economic burden of CIC in adults in the USA.

Methods: Two systematic literature searches of English-language publications on the humanistic and economic burden of CIC in adults in the USA were conducted using electronic databases and other resources. Both searches included the terms "chronic idiopathic constipation" and "functional constipation". Specific terms used in the search on humanistic burden included "quality of life", "SF-36", "SF-12", and "PAC-QOL"; search terms for economic burden included "cost", "resource use", "absenteeism", and "productivity".

Results: Overall, 16 relevant articles were identified. Health-related quality of life (HRQoL) appeared to be reduced in patients with CIC compared with controls and the general US population. Abdominal (r=0.33-0.49), stool (r=0.23-0.33), and rectal symptoms (r=0.53) appeared to be associated with reduced HRQoL. Younger age and female sex were associated with reduced overall HRQoL and greater symptom severity. Direct outpatient costs were higher in patients with CIC than those without CIC (US$6284 vs US$5254). Patients with CIC and abdominal symptoms reported more days of disrupted productivity per month than those without abdominal symptoms (3.2 days vs 1.2 days). The overall prevalence of complementary and alternative medicine use by patients with CIC was similar to that in the general US population.

Conclusion: The reduced HRQoL and increased costs associated with CIC indicate unmet therapeutic need in this disorder. Further research is required to better understand the humanistic and economic burden of CIC in the USA.

Keywords: chronic idiopathic constipation; economic burden; functional constipation; health-related quality of life.

Conflict of interest statement

AN is an employee of Shire, a member of the Takeda group of companies and has received stock from Takeda. SM is an employee of RTI Health Solutions, Ann Arbor, MI, USA. OO-A, DM, and MP are employees of RTI Health Solutions, Durham, NC, USA. RMV is an employee of RTI Health Solutions, Manchester, UK. RTI Health solutions received financial support from Shire Development LLC, a member of the Takeda group of companies for participation in the study design, data analysis, and data interpretation. The authors report no other conflicts of interest in this work.

© 2020 Nag et al.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection for articles reporting the humanistic burden of CIC in the USA. Abbreviations: CIC, chronic idiopathic constipation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Mean adjusted SF-36 component scores for patients with CIC and age- and sex-matched individuals without CIC in the USA. Notes: *p<0.05, **p<0.01 versus patients with CIC. Scores are adjusted for comorbidities. Reprinted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Quality of Life Research, The impact of functional constipation on quality of life of middle-aged black Americans: a prospective case-control study, Friedenberg FK, Dadabhai A, Palit A, Sankineni A, Copyright © (2012). Abbreviations: CIC, chronic idiopathic constipation; SF-36, 36-item Short-Form Health Survey
Figure 3
Figure 3
PAC-SYM and PAC-QOL scores in patients with CIC, stratified by (A) age and (B) sex. Notes: ***p<0.001 versus patients ≥60 years old. †p<0.05; ††p<0.01; †††p<0.001 versus men. Data from Nojkov et al. Abbreviations: CIC, chronic idiopathic constipation; PAC-QOL, Patient Assessment of Constipation Quality of Life questionnaire; PAC-SYM, Patient Assessment of Constipation Symptoms questionnaire.
Figure 4
Figure 4
Flow diagram of study selection for articles reporting the economic burden of CIC in the USA. Abbreviations: CIC, chronic idiopathic constipation; CINAHL, Cumulative Index of Nursing and Allied Health Literature; SLR, systematic literature review.
Figure 5
Figure 5
Mean predicted costs (2007–2008) for patients with CIC and age- and sex-matched controls. Notes: *p<0.05. Data from Herrick et al. Abbreviations: CIC, chronic idiopathic constipation; ER, emergency room.

References

    1. Sharma A, Rao S. Constipation: pathophysiology and current therapeutic approaches. Handb Exp Pharmacol. 2017;239:59–74.
    1. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(9):1582. doi:10.1038/ajg.2011.164
    1. Martin BC, Barghout V, Cerulli A. Direct medical costs of constipation in the United States. Manag Care Interface. 2006;19(12):43–49.
    1. Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25(5):599–608. doi:10.1111/j.1365-2036.2006.03238.x
    1. Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ 3rd. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol. 1992;136(2):165–177. doi:10.1093/oxfordjournals.aje.a116483
    1. Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150:1393–1407. doi:10.1053/j.gastro.2016.02.031
    1. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109(Suppl 1):S2–S26. doi:10.1038/ajg.2014.187
    1. Simren M, Palsson OS, Whitehead WE. Update on Rome IV criteria for colorectal disorders: implications for clinical practice. Curr Gastroenterol Rep. 2017;19(4):15. doi:10.1007/s11894-017-0554-0
    1. Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE, editors. Rome IV: Functional Gastrointestinal Disorders: Disorders of Gut-Brain Interaction. Raleigh, NC, USA: Rome Foundation Inc.; 2016.
    1. Rao SS, Meduri K. What is necessary to diagnose constipation? Best Pract Res Clin Gastroenterol. 2011;25(1):127–140. doi:10.1016/j.bpg.2010.11.001
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. doi:10.1371/journal.pmed.1000097
    1. Friedenberg FK, Dadabhai A, Palit A, Sankineni A. The impact of functional constipation on quality of life of middle-aged black Americans: a prospective case-control study. Qual Life Res. 2012;21(10):1713–1717. doi:10.1007/s11136-011-0089-z
    1. Chang L, Lembo AJ, Lavins BJ, et al. The impact of abdominal pain on global measures in patients with chronic idiopathic constipation, before and after treatment with linaclotide: a pooled analysis of two randomised, double-blind, placebo-controlled, Phase 3 trials. Aliment Pharmacol Ther. 2014;40(11–12):1302–1312. doi:10.1111/apt.12985
    1. Lewicky-Gaupp C, Morgan DM, Chey WD, Muellerleile P, Fenner DE. Successful physical therapy for constipation related to puborectalis dyssynergia improves symptom severity and quality of life. Dis Colon Rectum. 2008;51(11):1686–1691. doi:10.1007/s10350-008-9392-3
    1. Abel J, Taylor DC, Doshi JA, et al. Differences in demographic and symptom-related characteristics among patients with irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC): results from the Contor study. Gastroenterology. 2017;152(5 Suppl 1):S745. doi:10.1016/S0016-5085(17)32587-8
    1. Body C. Comparing quality of life indices in diabetics with constipation and normal or delayed colonic transit. Neurogastroenterol Motil. 2016;28(Suppl 1):35.
    1. Nojkov B, Baker J, Lee A, et al. Impact of age and gender to severity of constipation-related symptoms and quality of life indices in patients with chronic idiopathic constipation. Gastroenterology. 2017;152(5):S514–S515. doi:10.1016/S0016-5085(17)31896-6
    1. Herrick LM, Spalding WM, Saito YA, Moriarty J, Schleck C. A case-control comparison of direct healthcare-provider medical costs of chronic idiopathic constipation and irritable bowel syndrome with constipation in a community-based cohort. J Med Econ. 2017;20(3):273–279. doi:10.1080/13696998.2016.1253584
    1. Heidelbaugh JJ, Stelwagon M, Miller SA, Shea EP, Chey WD. The spectrum of constipation-predominant irritable bowel syndrome and chronic idiopathic constipation: US survey assessing symptoms, care seeking, and disease burden. Am J Gastroenterol. 2015;110(4):580–587. doi:10.1038/ajg.2015.67
    1. van Tilburg MA, Palsson OS, Levy RL, et al. Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO. BMC Complement Altern Med. 2008;8:46. doi:10.1186/1472-6882-8-46
    1. Wald A, Scarpignato C, Kamm MA, et al. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther. 2007;26(2):227–236. doi:10.1111/j.1365-2036.2007.03376.x
    1. Tack J, Camilleri M, Dubois D, Vandeplassche L, Joseph A, Kerstens R. Association between health-related quality of life and symptoms in patients with chronic constipation: an integrated analysis of three phase 3 trials of prucalopride. Neurogastroenterol Motil. 2015;27(3):397–405. doi:10.1111/nmo.12505
    1. Cai Q, Buono JL, Spalding WM, et al. Healthcare costs among patients with chronic constipation: a retrospective claims analysis in a commercially insured population. J Med Econ. 2014;17(2):148–158. doi:10.3111/13696998.2013.860375
    1. Sun S, Dibonaventura M, Purayidathil FW, Wagner J-S, Dabbous O, Mody R. Impact of chronic constipation on health-related quality of life, work productivity, and healthcare resource use: an analysis of the national health and wellness survey. Dig Dis Sci. 2011;56:2688–2695. doi:10.1007/s10620-011-1639-5
    1. Abbott R, Ayres I, Hui E, Hui KK. Effect of perineal self-acupressure on constipation: a randomized controlled trial. J Gen Intern Med. 2015;30(4):434–439. doi:10.1007/s11606-014-3084-6
    1. Adragna V, Mansueto G, Persico L, Salzarulo D, Quaranta C. Efficacy of osteopathic manipulative treatment on functional constipation: pilot study outcome research. Dig Liver Dis. 2016;48(2):e189. doi:10.1016/S1590-8658(16)30295-X
    1. Baker J, Chey S, Nojkov B, et al. Differences in disease specific quality of life between patients with dyssynergic defecation and chronic idiopathic constipation. Am J Gastroenterol. 2016;111:S243. doi:10.14309/00000434-201610001-00537
    1. Christie J, Shroff S, Shahnavaz N, et al. A randomized, double-blind, placebo-controlled trial to examine the effectiveness of lubiprostone on constipation symptoms and colon transit time in diabetic patients. Am J Gastroenterol. 2017;112(2):356–364. doi:10.1038/ajg.2016.531
    1. Cudmore S, Doolan A, Lacey S, Shanahan F. A randomised, double-blind, placebo-controlled clinical study: the effects of a synbiotic, Lepicol, in adults with chronic, functional constipation. Int J Food Sci Nutr. 2017;68(3):366–377. doi:10.1080/09637486.2016.1244661
    1. Iturrino J, Camilleri M, Wong BS, Linker Nord SJ, Burton D, Zinsmeister AR. Randomised clinical trial: the effects of daikenchuto, TU-100, on gastrointestinal and colonic transit, anorectal and bowel function in female patients with functional constipation. Aliment Pharmacol Ther. 2013;37(8):776–785. doi:10.1111/apt.12264
    1. Wong RK, Palsson OS, Turner MJ, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. Am J Gastroenterol. 2010;105(10):2228–2234. doi:10.1038/ajg.2010.200

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever