BackgroundIrritable bowel syndrome (IBS) affects 10–15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population.MethodsRespondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics.ResultsIn total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p < 0.001; mean PCS: 47.29 vs. 50.67; p < 0.001; mean SF-6D: 0.677 vs. 0.741; p < 0.001) and greater absenteeism (5.1% vs. 2.9%; p = 0.004), presenteeism (17.9% vs. 11.3%; p < 0.001), overall work productivity loss (20.7% vs. 13.2%; p < 0.001), and activity impairment (29.6% vs. 18.9%; p < 0.001). Respondents with IBS-D also incurred an estimated $2486 more in indirect costs ($7008 vs. $4522; p < 0.001).ConclusionsCompared with controls, IBS-D is associated with significantly lower HRQoL, greater impairments in work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.

BACKGROUND: The prevalence of irritable bowel syndrome with constipation (IBS-C) is estimated to be between 4.3% and 5.2% among adults in the United States. Little is known about the health care resource utilization and costs associated with IBS-C.

In pair-wise comparisons of active treatment arms to one another, results suggest vernakalant IV, propafenone IV and flecainide appear to be effective in achieving rapid cardioversion in patients with short duration AF compared to other agents. Application of these findings to clinical practice need to account for the variable comorbidity profiles of patients, important determinants in the selection of appropriate therapy for individual patients. Though best practice methods were used, further research comparing treatments through direct head-to-head comparisons may be warranted to confirm these findings and further inform clinical practice.

This study was funded by Allergan. The authors received no compensation related to the development of the manuscript. Buono and Andrae are employees of Allergan. Mathur is an employee of Axtria. Averitt was an employee of Axtria at the time this study was conducted. Data from this manuscript have previously been presented in poster format by Buono at the American College of Gastroenterology Annual Scientific Meeting; Honolulu, Hawaii; October 16-21, 2015. Mathur and Averitt were involved in conducting the study analyses. All authors were involved in the study design, interpretation of the data, and preparation of the manuscript. The authors take full responsibility for the scope, direction, and content of the manuscript and have approved the submitted manuscript.

CC imposes a substantial burden in direct healthcare costs in a commercially insured population, mainly attributable to greater use of medical services.

OBJECTIVES: Infliximab is indicated in Crohn's disease (CD) resistant to standard treatment (ST), but its impact on health care costs and quality-adjusted life-expectancy is incompletely understood. We assessed the cost-effectiveness of episodic (ET) and maintenance (MT) infliximab treatment in CD patients with 10-years follow-up. METHODS: A total of 212 incident adult CD patients (age at onset 34.4Ϯ14.5 years, 49.4% male) were treated with antibiotics, mesalazine, corticosteroids, thiopurines, surgery (comprising ST) over 10-years to 2004. Eight health states were defined by intensity of therapy in these patients. We determined Markov transition probabilities between these states, health care costs and QALYs in 3 month-cycles. This cohort was modeled to allow drug-refractory or pre-surgery patients to receive infliximab: either ET in one cycle, or MT in responders for a period of 1-year (MT-1yr) or for 10-years (MT-10 yrs). Transition probabilities of ST were applied to patients getting IFX; the probability of continuing infliximab in MT was set to correct for decay. Health care costs and QALYs in ET and MT were estimated for 10-years (discounted at 3%) and compared with those of ST patients. RESULTS:The average cost (QALYs gained) per patient over 10-years was €23,169 (6.7014) for ST; €21,691 (7.0403) for ET, €29,012 (7.0553) for MT-1yr, and €50,416 (7.2603) for MT-10 yrs. ST was associated with higher costs and lower outcomes and was thus dominated by ET. The incremental cost-effectiveness ratios (ICERs) of MT-1yr and MT-10 yrs over ST were €16,510/QALY gained, and €48,751/QALY gained, respectively. When compared with ET, the ICERs of MT-1yr and MT-10 yrs were €488,066/QALY gained, and €130,568/QALY gained, respectively. When the infliximab price was halved these ICERs remained very high. CONCLUSIONS: ET or MT with infliximab are either cost-saving or cost-effective when compared with ST. However, at current drug prices, MT does not provide good value for money when compared with ET. OBJECTIVES:To evaluate direct medical costs, health outcomes, and cost-effectiveness of 48-week Peginterferon alpha-2a with 2nd line 2-years Entecavir treatment versus 3 years Entecavir treatment for HBeAg-positive chronic hepatitis B according to the Response Guided Treatment (RGT) strategy in China. METHODS: A Markov model was designed to evaluate the direct medical costs and outcomes (life years and QALYs gained) of treating HBeAg-positive chronic hepatitis B in China, with a maximum analysis time horizon of 80 years. The model included 10 health states -Chronic hepatitis B (CHB), HBeAg seroconversion, HBsAg loss, CHB with resistance, Compensated cirrhosis, Decompensated cirrhosis, Hepatocellular carcinoma, Liver transplant, Post-liver transplant and death. Based on the analysis of published literature, a two-round expert panel survey was conducted among 22 hepatitis B specialists nationally to identify clinical and utility data. From the perspective of China's health insurance system, cost data was calculated based on the publ...

Inadequate symptom control associated with available IBS-D therapies represents a significant economic burden for both payers and IBS-D patients.

Objectives: Clostridium difficile infection (CDI) costs the US health care system over $3 billion annually. Current guidelines recommend metronidazole as first-line therapy in most instances of CDI. However, vancomycin is recommended for recurrent CDI (RCDI). A growing body of evidence supports the use of fecal microbiota transplantation (FMT) as a therapeutic option for RCDI. This study explores cost-effectiveness of FMT and vancomycin versus metronidazole for initial CDI. MethOds: We constructed a decision-analytic computer simulation using inputs from the published literature to compare a 10-14-day course of oral metronidazole or vancomycin to FMT for initial CDI. Parameters included cure rates (range) for metronidazole [80% (65-85%)], vancomycin [90% (88-92%)] and FMT [91% (83-100%)]. The direct costs (range) of metronidazole, vancomycin and FMT, adjusted to 2011 dollars, were $57