Health Economic Studies Are Important for Patients With Irritable Bowel Syndrome and Their Gastroenterologists

Shah, Eric D.; Ballou, Sarah

doi:10.1016/j.cgh.2020.05.022

Cited by 6 publications

(7 citation statements)

References 12 publications

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Section: Discussionsupporting

confidence: 59%

“…In our study, we found that time and financial commitments needed complete treatment (i.e., taking a pill, compared to completing several medical appointments to complete CBT or paying for low FODMAP food) as well as treatment impact on missed work-days due to IBS are important from a patient perspective and should be incorporated into shared decision making. 30,31 These findings validate and provide a rationale for common patient questions and discussion topics in managing IBS-C in current practice. [32][33][34] While our model favored SSRI, these drugs are not labeled for an IBS-C indication and have weaker supporting data compared to the FDA-approved IBS-C treatments of linaclotide, plecanatide, and lubiprostone, drugs that were carefully evaluated in rigorous multicenter trials.…”

Section: Discussionsupporting

confidence: 57%

“…Appendix Figures 10 to 38 detail the influence of specific model inputs on cost-effectiveness outcomes when comparing two competing IBS-C therapies, from payer perspectives (Appendix Figures 10-23) and patient perspectives (Appendix Figure [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. All analyses assessed whether differences in health utility gains with therapy, as well as responder and discontinuation rates would influence treatment preferences based on cost-effectiveness compared to our base-case findings.…”

Section: Specific Factors Influencing Relative Cost-effectivenessmentioning

confidence: 99%

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Pharmacologic, Dietary, and Psychological Treatments for Irritable Bowel Syndrome With Constipation: Cost Utility Analysis

Shah

Salwen‐Deremer

Muir

et al. 2021

MDM Policy & Practice

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Introduction. Irritable bowel syndrome (IBS) is the most common gastroenterology referral and one of the most common gastrointestinal complaints in primary care. We performed a cost-utility analysis of the most common treatments available in general practice for IBS with constipation (IBS-C), the most expensive IBS subtype. Methods. We developed a decision analytic model evaluating guideline-recommended and Food and Drug Administration–approved drugs, supplements, and dietary/psychological interventions. Model inputs were derived from “global symptom improvement” outcomes in systematic reviews of clinical trials. Costs were derived from national datasets. Analysis was performed with a 1-year time horizon from patient and payer perspectives. We analyzed a prototypical managed-care health plan with no cost-sharing to the patient. Results. From a payer perspective, global IBS treatments (including low FODMAP, cognitive behavioral therapy [CBT], neuromodulators), which are not specific to the IBS-C bowel subtype were less expensive than on-label prescription drug treatments. From a patient perspective, on-label prescription drug treatment with linaclotide was the least expensive treatment strategy. Drug prices and costs to manage untreated IBS-C were most important determinants of payer treatment preferences. Effects of treatment on missed work-days and need for repeated appointments to complete treatment were the most important determinants of treatment preference to patients. Discussion. Due mostly to prescription drug prices, neuromodulators, low FODMAP, and CBT appear cost-effective compared to on-label drug treatments from a payer perspective in cost-utility analysis. These findings may explain common treatment barriers in clinical practice.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 57%

Section: Specific Factors Influencing Relative Cost-effectivenessmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacologic, Dietary, and Psychological Treatments for Irritable Bowel Syndrome With Constipation: Cost Utility Analysis

Shah

Salwen‐Deremer

Muir

et al. 2021

MDM Policy & Practice

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“…Given the chronicity and significant quality-of-life impact experienced by patients with IBS, lifestyle and personal contexts may dramatically impact patient preferences. Thus, rather than seeking to establish a single best therapy for all patients, gastroenterologists should utilize shared decision-making to establish which factors are most important to each individual patient and therefore which therapy may be the best fit [80]. Engaging patients in conversations about their treatment goals may lead to better satisfaction and even better success with treatment.…”

Section: Shared Decision Making In Ibsmentioning

confidence: 99%

Diarrhea-Predominant and Constipation-Predominant Irritable Bowel Syndrome: Current Prescription Drug Treatment Options

Wechsler

Shah

2021

Drugs

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Irritable bowel syndrome (IBS) is a heterogenous disease with a variety of therapeutic options, including eight prescription drugs approved for use in IBS in the USA. Choosing among the myriad treatment options requires attention to patient preferences both on clinical outcomes and costs associated with treatment. We performed a narrative review of the literature to summarize these important determinants of treatment choice including: labeled indications; clinical profiles of efficacy, safety, and tolerability of prescription drugs; and cost-effectiveness for diarrhea-predominant IBS drugs (IBS-D: alosetron, eluxadoline, and rifaximin) and constipation-predominant IBS drugs (IBS-C: linaclotide, lubiprostone, plecanatide, tegaserod, and tenapanor). We then review the standard model of shared decision-making aimed at guiding an informed, patient-centered discussion to integrate comparative clinical and cost outcomes toward choosing an IBS treatment in practice.

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“…The concept of intergenerational transmission of illness behaviors was further explored by Levy and colleagues [ 20 ] and van Tilburg and colleagues [ 21 ] in studies of children of parents with Irritable Bowel Syndrome (IBS), a gastrointestinal complex of symptoms including chronic pain with no known etiology and high rates of disability [ 22 , 23 , 24 , 25 ]. They found children whose parents had a diagnosis of IBS had significantly higher healthcare utilization rates, not just for gastrointestinal symptoms but also for a wide range of somatic symptoms, as compared to a control group of children whose parents were not diagnosed with IBS.…”

Section: Introductionmentioning

confidence: 99%

Parental Response to Only Children: Breaking the Stereotypes

et al. 2021

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While much has been written about the relationship between only child status and parents’ behavior toward children, and consequent personality and intelligence, little is known about the relationship between only child status, parental response to illness, and subsequent child illness behavior. In this study, 227 mothers of 342 children completed measures designed to assess: (a) their children’s school attendance, (b) their own psychological status, and (c) their own responses to their children’s expressions of stomach pain. Parents of only children were more likely to minimize their children’s gastrointestinal symptoms than were parents of children with at least one sibling. In addition, only children were less likely to miss school. Parental protectiveness did not differ as a function of only child status. These findings are somewhat discrepant with commonly held beliefs about parents’ patterns of responding to only children.

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Health Economic Studies Are Important for Patients With Irritable Bowel Syndrome and Their Gastroenterologists

Cited by 6 publications

References 12 publications

Pharmacologic, Dietary, and Psychological Treatments for Irritable Bowel Syndrome With Constipation: Cost Utility Analysis

Pharmacologic, Dietary, and Psychological Treatments for Irritable Bowel Syndrome With Constipation: Cost Utility Analysis

Diarrhea-Predominant and Constipation-Predominant Irritable Bowel Syndrome: Current Prescription Drug Treatment Options

Parental Response to Only Children: Breaking the Stereotypes

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