Mitra D, Davis KL, Baran R. Health care utilization and costs associated with constipation (C-ONLY) and co-occurring irritable bowel syndrome and constipation (IBS+C) compared to migraine in a large managed care population. Poster presented at the 2007 ISPOR 12th Annual International Meeting; May 22, 2007. [abstract] Value Health. 2007 May; 10(3):A148-9.

OBJECTIVES: Health care utilization and costs may be elevated among patients with C-ONLY and IBS+C. Migraine is an appropriate comparator because it is chronic, costly, and nongastrointestinal. Health care utilization and costs were evaluated for these three groups.

METHODS: A large US health plan claims database was retrospectively analyzed from January 2003 through December 2005. Three mutually exclusive cohorts were identified: 1) C-ONLY: ICD-9 564.0x (N = 91,632); 2) IBS+C: ICD-9 564.1 and 564.0x (N = 10,952); and 3) Migraine: ICD- 9 346.xx (N = 101,418). Per patient use and costs (charged amounts) of medical services and prescriptions were assessed over a period of 3 months prior to and 9 months following first diagnosis. Patients had continuous health plan enrollment during this period.

RESULTS: Total health care charges were $15,808 and $16,378 for patients with C-ONLY and IBS+C compared to $10,405 among patients with migraine (difference $5403 and $5,973, both P < 0.0001). Inpatient charges were approximately 2.5 times higher for the C-ONLY cohort and 1.7 times higher for the IBS+C cohort compared to migraine ($5112 and $3,625, vs. $2093; both P < 0.0001). Both cohorts had higher charges for office visits compared to migraine ($2460 and $3,050, vs. $2282; both P < 0.0001). Charges for hospital outpatient services were $3913 and $4738 for patients with C-ONLY and IBS+C, respectively, compared to $2784 for migraine (both P < 0.0001), while charges for other ancillary services were $2578 and $2627 for C-ONLY and IBS+C, respectively, compared to $1444 for migraine (both P < 0.0001). Prescription drug charges were slightly lower for C-ONLY, but higher for IBS+C compared to migraine ($1438 and $2053 vs. $1551; both P < 0.0001). Charges for ER visits were higher for both cohorts compared to migraine ($307 vs. $251, P < 0.0001 and $284 vs. $251, P = 0.0059).

CONCLUSION: C-ONLY and IBS+C are costly conditions that present greater economic burden to payers compared to migraine. Institutional costs are primary drivers for constipation expenditures.