Use of drugs, nondrug treatments for functional bowel disorders analyzed
One study found that nonpharmacologic interventions are underused in ambulatory care visits for functional bowel disorders, while another found that patients with irritable bowel disease and their insurers have financial incentives to favor differing treatments.
Nonpharmaceutical interventions are underused in ambulatory care for functional bowel disorders (FBDs), according to a new study.
Researchers used data from the National Ambulatory Medical Care Survey to analyze more than 36 million visits for chronic symptomatic FBDs from 2007 to 2015. They found an annual weighted average of 2.7 million visits for symptomatic irritable bowel syndrome (IBS)/chronic abdominal pain, 1.0 million visits for chronic constipation, and 0.7 million visits for chronic diarrhea. Results were published by Gastroenterology on Sept. 30.
The studied visits resulted in prescription of pharmacologic therapies 49.7% (95% CI, 44.7% to 54.8%) of the time and nonpharmacologic interventions 19.8% (95% CI, 16.0% to 24.2%) of the time (P<0.001). Combination treatment, with both pharmacologic and nonpharmacologic strategies, was more likely when patients were treated by a primary care physician (rather than a subspecialist) or had depression or obesity. About two-thirds of the patients were women, one in seven had depression, and only about one in five visits was a new consultation for the symptoms. The study authors estimated the annual cost of ambulatory clinic visits for chronic symptomatic FBDs at about $358 million.
“Despite this substantial economic burden and the high rate of repeated visits among symptomatic patients, we identify a potential gap in comprehensive FBD care as most patients in this study population did not receive non-pharmacologic treatment advice on diet, exercise, stress reduction, mental health counseling or mind-body interventions. Furthermore, the likelihood of receiving a combined medication and non-pharmacologic approach for managing chronic symptomatic FBDs varies by provider, geographic region, and patient profile,” the authors said.
They noted that as a cross-sectional analysis, the study couldn't establish which therapies the patients might have already tried without success, among other limitations. The authors also listed a number of barriers to greater use of nonpharmacologic interventions, including the need for specialized expertise and the greater time, effort, and costs involved. They encouraged development of initiatives to increase uptake of diet, exercise, stress reduction, and mental health counseling in symptomatic patients, with subsequent evaluation of their impact on health care utilization.
Another recent study evaluated the cost benefits of pharmacologic and nonpharmacologic interventions for patients with IBS with diarrhea. Researchers used a decision analytic model to assess drugs, supplements, a diet low in fermentable oligo-, di-, and monosaccharides and polyols, and cognitive behavioral therapy (CBT). They found that from an insurer's perspective, the approved prescription drugs were a significantly more expensive way to treat the condition than off-label treatments, diet, or CBT. However, from a patient perspective, prescription drug therapies and neuromodulators appeared preferable due to associated reductions in lost wages and out-of-pocket costs. The authors concluded that these findings may explain misalignment between patient and insurer treatment preferences in practice. The study was published by Clinical Gastroenterology and Hepatology on Sept. 30.
The authors noted that their results showed that patients' average costs to manage IBS are high (about $1,850 per year for the most effective option). “Our findings suggest that these non-obvious costs are important in patient-centered shared decision-making on appropriate IBS therapy and that costs should be discussed with patients,” they wrote.