Health-related quality of life and health care costs in severe, refractoryirritable bowel syndrome

Background: The irritable bowel syndrome (IBS) may lead to considerable imp airment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bower sy mptoms or reflect a coexisting psychiatric disorder. Objective: To determine whether bowel symptom severity and psychological sy mptoms directly influence health-related quality of life and health care co sts. Design: Cross-sectional survey. Setting: secondary and tertiary gastroenterology clinics. Patients: 257 patients with severe IBS who did not respond to usual treatme nts and were recruited for a trial of psychological treatment. Measurements: Predictors were abdominal pain, entries in a diary of 10 IBS symptoms, and measures of psychological symptoms. Outcomes were inability t o work, health-related quality of life (measured by Medical Outcomes Survey 36-item short-form questionnaire [SF-36] physical component summary scores ), and health care and productivity costs. Predictor and outcome measures w ere compared by using multiple regression and logistic regression analyses. Results: Abdominal pain occurred on average 24 days per month and activitie s were restricted on 145 days of the previous 12 months. The mean (+/- SD) Hamilton depression score was 11.3 +/-6.1. The SF-36 physical component sum mary score was low (37.7 +/- 10.6), and the patients had incurred high heal th care costs ($1743 +/- $2263) over the previous year. Global severity and somatization scores on the Symptom Checklist 90 Revised, abdominal pain, a nd Hamilton depression scores independently contributed to the physical com ponent score of the SF-36 (adjusted R-2 = 35.2%), but only psychological sc ores were associated with disability due to ill health. These variables did not accurately predict health care or other costs (adjusted R-2 = 9.3%), H istory of sexual abuse was not an independent predictor of outcome. Conclusions: Both abdominal and psychological symptoms are independently as sociated with impaired health-related quality of life in patients with seve re IBS, Optimal treatment is likely to require a holistic approach. Since h ealth care and loss of productivity costs are not clearly associated with t hese symptoms, alleviation of them will not necessarily lead to reduced cos ts.