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

IF 1.7
MDM policy & practice Pub Date : 2021-01-18 eCollection Date: 2021-01-01 DOI:10.1177/2381468320978417
Eric D Shah, Jessica K Salwen-Deremer, Peter R Gibson, Jane G Muir, Shanti Eswaran, William D Chey
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引用次数: 11

Abstract

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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肠易激综合征伴便秘的药物、饮食和心理治疗:成本效用分析。
介绍。肠易激综合征(IBS)是最常见的胃肠病学转诊和最常见的胃肠道主诉之一,在初级保健。我们对最昂贵的IBS亚型IBS合并便秘(IBS- c)的一般治疗中最常见的治疗方法进行了成本-效用分析。方法。我们开发了一个决策分析模型来评估指南推荐和食品和药物管理局批准的药物、补充剂和饮食/心理干预。模型输入来自临床试验系统评价的“整体症状改善”结果。费用来源于国家数据集。从患者和支付方的角度进行了为期1年的分析。我们分析了一个典型的管理式医疗保健计划,该计划没有对患者分摊费用。结果。从支付方的角度来看,全球IBS治疗(包括低FODMAP、认知行为治疗[CBT]、神经调节剂)并不针对IBS- c肠道亚型,比标签上的处方药治疗更便宜。从患者的角度来看,使用利那洛肽的处方药物治疗是最便宜的治疗策略。治疗未经治疗的IBS-C的药品价格和费用是付款人治疗偏好的最重要决定因素。治疗对错过工作日的影响和需要重复预约完成治疗是患者治疗偏好的最重要决定因素。讨论。在成本效用分析中,从付款人的角度来看,与标签上的药物治疗相比,神经调节剂、低FODMAP和CBT似乎更具成本效益,这主要是由于处方药的价格。这些发现可以解释临床实践中常见的治疗障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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