The Current Management And Costs Of Irritable Bowel Syndrome With Constipation In Belgium: A 2-Round Expert Survey

Patients suffering from irritable bowel syndrome (IBS) with constipation (IBS-C) receive laxatives as first line therapy. In spite of these laxatives most of them experience failure. We aimed at describing the current management and its costs of Belgian IBS-C patients who failed first line treatment. A 2-round Delphi panel was conducted including general practitioners (GP) and gastroenterologists. The type and frequency of medical resources used per year as second-line IBS-C therapy (consultations, exams/tests, drugs, hospitalizations) were collected, reflecting the expert’s own practice in the first round and finding a Belgian consensus in the second round. Two patients’ profiles were defined: second line current management and third line management in case of second line failure. Unit costs (2012 INAMI/RIZIV tariffs) were assigned to the resources used to calculate a cost per patient-year and a range based on the distribution of experts’ answers. Eleven experts participated (6 GPs/5 gastroenterologists). The drugs prescribed in second line were laxatives (71.4%, mainly osmotics), spasmolytics (72.2%), pain killers (11.5%) and antidepressants (6.0%). There were 7.7 consultations per patient-year on average (GP: 5.3; specialists: 2.4). Emergency room visits occurred in 10.4% and diagnostic tests included thyroid function (79.1%), rectosigmoidoscopy (39.8%) and abdominal echography (36.8%). There were 0.97 IBS-related admissions to hospital per patient-year. After a second line failure, resource use increased with more laxatives (75.5%), antidepressants (24.6%) and pain killers (17.3%), 11.6 consultations (GP: 7.5; specialist: 4.1), 14.5% emergency room visits and 1.25 hospitalizations. Diagnostic tests were also more frequent (rectosigmoidoscopy: 49.3%; abdominal echography: 43.6%) except thyroid function (70.0%). The annual cost of second line was €2,114 [1,509;2,819] versus €2,920 [2,072;3,917] after second line failure. Hospitalizations accounted for about 75% of the costs. IBS with constipation leads to significant resource use and high costs certainly in case of second line treatment failure.